Effects of Lung-Protective Ventilation on Cerebral Oxygenation During One-Lung Ventilation in Neonates

Lei Lv,1 Wei-Zhi Zhang,1 Hong-Peng Zhang,1 Yun-Wei Wei,1 Jin-Wei Duan,1 Jun-Ming Ren2 1Department of Anesthesiology, Shanxi Provincial Children’s Hospital, Taiyuan, Shanxi, 030013, People’s Republic of China; 2Department of Anesthesiology, Shanxi Provincial People’s Hospital, Taiyuan, Shanxi, 030012, People’s Republic of ChinaCorrespondence: Jun-Ming Ren, Department of Anesthesiology, Shanxi Provincial People’s Hospital, Taiyuan, Shanxi, 030012, People’s Republic of China, Tel +86 03514960423, Email [email protected]: This study aimed to investigate the effects of different lung ventilation strategies on cerebral oxygen saturation (rSO2) during one-lung ventilation (OLV) in neonates.Methods: A total of 50 neonates scheduled for elective OLV between October 2022 and April 2024 were enrolled and randomly assigned to either the control group (Group C) or the study group (Group S). In Group S, the respiratory rate was adjusted to maintain end-tidal carbon dioxide (PETCO2) levels between 45– 55 mmHg at 30 minutes of OLV (T3) and subsequently restored to normal levels (35– 45 mmHg) at 45 minutes of OLV (T4). Lung recruitment maneuvers were applied. In Group C, PETCO2 was maintained within the normal range throughout the procedure. Oxygen saturation (SpO2) and rSO2, along with additional physiological parameters, were recorded at five time points: before OLV (T1), 15 minutes after OLV initiation (T2), T3, T4, and 60 minutes after OLV initiation (T5). Arterial blood samples were collected for blood gas analysis.Results: In both groups, rSO2 levels significantly decreased during OLV compared to baseline (T1) (p < 0.05). However, at T3, rSO2 was significantly higher in Group S compared to Group C. Comparisons within the group indicated that rSO2 in Group S at T3 was significantly higher than at T5. Lung compliance was superior in Group S compared to Group C at T5. Furthermore, lung compliance in both groups decreased at T2 when compared to T1 (p < 0.05).Conclusion: Despite maintaining SpO2 within the normal range, rSO2 declined during OLV in neonates. The application of permissive hypercapnia during OLV improved rSO2 within a certain range. Routine perioperative monitoring of rSO2 in neonates undergoing OLV may facilitate early detection of cerebral oxygenation changes, contributing to neuroprotection.Keywords: cerebral oxygen saturation, hypercapnia, lung protected ventilation, lung recruitment, neonates, one lung ventilation