Acute Permissive Hypercapnia during One Lung Ventilation: Impact on Right Ventricular Function during Lung Resection

Background: In a quasi-experimental design study, the haemodynamic and gas exchange effects of acute permissive hypercapnia and its effect on right ventricle during one-lung ventilation in 15 thoracotomy patients who had lung resetion, were investigated.Methods: Hypercapnia was induced by decreasing tidal volume until PaCO2 increased to 60-70mmHg.Results: Cardiac index (from 2.93±0.44 to 3.37±0.54l min–1 m^–2, p-value 0.001), tricuspid annular plane systolic excursion (2.16±0.15 to 2.4±0.17cm, p-value 0.001) and right ventricular myocardial performance index (0.319±0.01 to 0.33±0.0, p-value 0.001) increased with hypercapnia. Systemic and pulmonary oxygenation improved.Conclusion: Permissive hypercapnia as a component of OLV management is likely to be beneficial in selected patients. PaCO2 levels up to 60-70mmHg are likely to be tolerated in the short-term and clearly beneficial in terms of lung injury attenuation.