A randomised controlled trial on roles of prostaglandin E1 nebulization among patients undergoing one lung ventilation
BMC PULMONARY MEDICINE(2022)
Abstract
Background Prostaglandin E1 (PGE1) has been reported to maintain adequate oxygenation among patients under 60% FiO 2 one-lung ventilation (OLV). This research aimed to explore whether PGE1 is safe in pulmonary shunt and oxygenation under 40% FiO 2 OLV and provide a reference concentration of PGE1. Methods Totally 90 esophageal cancer patients treated with thoracotomy were enrolled in this study, randomly divided into three groups (n = 30/group): Group A (60% FiO 2 and 0.1 µg/kg PGE1), Group B (40% FiO 2 and 0.1 µg/kg PGE1), and Group C (40% FiO 2 , 0.2 µg/kg PGE1). Primary outcomes were oxygenation and pulmonary shunt during OLV. Secondary outcomes included oxidative stress after OLV. Results During OLV, patients in Group C and B had lower levels of PaO 2 , SaO 2 , SpO 2 , MAP, and Qs/Qt than those in Group A ( P < 0.05). At T2 (OLV 10 min), patients in Group C and B exhibited a lower level of PaO 2 /FiO 2 than those in Group A, without any statistical difference at other time points. The IL-6 levels of patients in different groups were different at T8 (F = 3.431, P = 0.038), with IL-6 in Group C being lower than that in Group B and A. MDA levels among the three groups differed at T5 (F = 4.692, P = 0.012) and T7 (F = 5.906, P = 0.004), with the MDA level of Group C being lower than that of Group B and A at T5, and the MDA level of Group C and B being lower than that of Group A at T7. In terms of TNF-α level, patients in Group C had a lower level than those in Group B and A at T8 (F = 3.598, P = 0.033). Compared with patients who did not use PGE1, patients in Group C had comparable complications and lung infection scores. Conclusion The concentration of FiO 2 could be reduced from 60 to 40% to maintain oxygenation. 40% FiO 2 + 0.2 µg/kg PGE1 is recommended as a better combination on account of its effects on the inflammatory factors. Trial registration: Chictr.org.cn identifier: ChiCTR1800018288, 09/09/2018.
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Key words
Prostaglandin E1, One-lung ventilation, 40% FiO(2), Randomised controlled trial
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