Abstract:

Objective To investigate the effect of driving pressure （DP） guided ventilation strategy on regional cerebral oxygen saturation （S_rcO₂） in infants with one lung ventilation （OLV） during thoracoscopic surgery. Methods Sixty infants undergoing elective thoracoscopic surgery were randomly divided into control group （group C，n = 30）and driving pressure group （group DP， n = 30）. Near?infrared spectroscopy was used to monitor S_rcO₂ during OLV. Cerebral oxygen desaturation （COD）was defined as SrcO2 decreased by more than 20% from baseline. The incidence of hypotension， time of ventilation rescue， the incidence of COD and its duration during OLV were recorded. MAP， HR， S_rcO₂， PEEP， airway peak pressure （Ppeak）， static lung compliance （Cs） were recorded before （T₁）， 30 min after （T₂） and 60 min after （T₃）artificial pneumothorax， and results of arterial blood gas analysis on T₁ and were T₂ compared. Results There were no significant differences in the S_rcO₂ baseline， the mean S_rcO₂ during OLV， the incidence of hypotension and the incidence of COD between the two groups （P > 0.05）. Times of ventilation rescue and COD duration in DP group were lower than those in C group（P < 0.05）. There were no significant differences in MAP， HR， S_rcO₂， Ppeak， Cs， PaO₂ and OI between the two groups at T₁ （P > 0.05）. Compared with T₁， Ppeak increased and S_rcO₂ and Cs decreased in both groups at T₂ and T₃ （P < 0.05）. Compared with group C， group DP had higher PaO₂ and OI at T₂， lower Ppeak and higher PEEP and Cs at T₂ and T₃（P < 0.05）. Conclusion DP guided ventilation strategy improved lung compliance， increased oxygen saturation and shortened the exposure of COD in infants during OLV.

Key words: driving pressure, cerebral oxygenation, one?lung ventilation, infant, thoracoscopic surgery