Effects of dexmedetomidine on oxygenation and lung mechanics in patients with moderate chronic obstructive pulmonary disease undergoing lung cancer surgery: A randomised double-blinded trial

Su Hyun Lee, Namo Kim, Chang Yeong Lee, Min Gi Ban, Young Jun Oh, Su Hyun Lee, Namo Kim, Chang Yeong Lee, Min Gi Ban, Young Jun Oh

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is a risk factor that increases the incidence of postoperative cardiopulmonary morbidity and mortality after lung resection. Dexmedetomidine, a selective α2-adrenoreceptor agonist, has been reported previously to attenuate intrapulmonary shunt during one-lung ventilation (OLV) and to alleviate bronchoconstriction.

Objective: The objective is to determine whether dexmedetomidine improves oxygenation and lung mechanics in patients with moderate COPD during lung cancer surgery.

Design: A randomised, double-blinded, placebo-controlled study.

Setting: Single university hospital.

Participants: Fifty patients scheduled for video-assisted thoracoscopic surgery who had moderate COPD. Patients were randomly allocated to a control group or a Dex group (n = 25 each).

Interventions: In the Dex group, dexmedetomidine was given as an initial loading dose of 1.0 μg kg(-1) over 10 min followed by a maintenance dose of 0.5 μg kg(-1) h(-1) during OLV while the control group was administered a comparable volume of 0.9% saline. Data were measured at 30 min (DEX-30) and 60 min (DEX-60) after dexmedetomidine or saline administration during OLV.

Main outcome measures: The primary outcome was the effect of dexmedetomidine on oxygenation. The secondary outcome was the effect of dexmedetomidine administration on postoperative pulmonary complications.

Results: Patients in the Dex group had a significantly higher PaO2/FIO2 ratio (27.9 ± 5.8 vs. 22.5 ± 8.4 and 28.6 ± 5.9 vs. 21.0 ± 9.9 kPa, P < 0.05), significantly lower dead space ventilation (19.2 ± 8.5 vs. 24.1 ± 8.1 and 19.6 ± 6.7 vs. 25.3 ± 7.8%, P < 0.05) and higher dynamic compliance at DEX-30 and DEX-60 (P = 0.0001 and P = 0.0184) compared with the control group. In the Dex group, the PaO2/FIO2 ratio in the postoperative period was significantly higher (P = 0.022) and the incidence of ICU admission was lower than in the control group.

Conclusion: Dexmedetomidine administration may provide clinically relevant benefits by improving oxygenation and lung mechanics in patients with moderate COPD undergoing lung cancer surgery.

Trial registration: ClinicalTrial.gov identifier: NCT 02185430.

Trial registration: ClinicalTrials.gov NCT02185430.

Figures

Fig. 1
Fig. 1
Study flow diagram.
Fig. 2
Fig. 2
Respiratory changes in 50 patients with moderate COPD during OLV. (a) PaO2/FiO2 ratio, (b) deadspace ventilation (Vd/Vt). Data are mean with error bars showing SD. ∗P < 0.05 versus OLV, †P < 0.05 vs. control group. COPD, chronic obstructive pulmonary disease; Dex, dexmedetomidine group; Control, control group; OLV, 30 min after initiation of OLV; DEX-30, 30 min after dexmedetomidine administration during OLV; DEX-60, 60 min after dexmedetomidine administration during OLV; OLV, one-lung ventilation; Vd, dead space volume; Vt, tidal volume.

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