Effects of phenylephrine and norepinephrine with restrictive infusion on oxygenation during one-lung ventilation for lung surgery - a randomized controlled trial

Q: What was the main objective of this study during one-lung ventilation?

To compare how norepinephrine or phenylephrine combined with restrictive infusion affected oxygenation during thoracoscopic one-lung ventilation.

Q: How were oxygenation and shunt fraction evaluated across the study groups?

PaO2 and Qs/Qt were measured in lateral positions during two-lung ventilation at 10 minutes, and during one-lung ventilation at 15 and 45 minutes.

Q: What did the study find about phenylephrine versus the other groups at 45 minutes of OLV?

At 45 minutes, the phenylephrine group showed higher PaO2 and lower Qs/Qt than the norepinephrine and control groups, with no significant difference between norepinephrine and control.

Sep 30, 2026

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This randomized controlled trial compared norepinephrine versus phenylephrine, each combined with restrictive infusion, on oxygenation during thoracoscopic one-lung ventilation (OLV) in lung surgery. Ninety patients were assigned to norepinephrine (N), phenylephrine (P), or control (C). PaO2 and intrapulmonary shunt fraction (Qs/Qt) were assessed at 10 minutes after two-lung ventilation and at 15 and 45 minutes during OLV. Lung tissue endothelin and COX-2 were measured after surgery.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Abstract

Methods

Groups and measurements

Results

Oxygenation and shunt changes

Endothelin and COX-2 in lung tissue

Conclusion

Key messages

Introduction

AnnAls of Medicine 2026, Vol. 58, no. 1, 2611655 [https://doi.org/10.1080/07853890.2025.261](https://doi.org/10.1080/07853890.2025.261)1655 RESEARCH ARTICLE Effects of phenylephrine and norepinephrine with restrictive infusion on oxygenation during one-lung ventilation for lung surgery: a randomized controlled trial Jiaxin Lia, Xiangjie Liub, Longhe Xua, Yi Liua and Yongzhe Liua adepartment of Anesthesiology, The Third Medical center of PlA General Hospital, Beijing, china; bdepartment of Anesthesiology, Jinzhou Medical University, Jinzhou, liaoning, china ABSTRACT Objective: This study compared the effects of norepinephrine or phenylephrine combined with restrictive infusion on the oxygenation during thoracoscopic one-lung ventilation (OLV). Methods: Ninety patients were randomly divided into three groups: the norepinephrine group (Group N), the phenylephrine group (Group P), and the control group (Group C). Arterial partial pressure of oxygen (PaO2) and intrapulmonary shunt fraction (Qs/Qt) were measured with patients in lateral positions during two-lung ventilation (TLV) at 10 min (T1), and during OLV at 15 min (T2) and 45 min (T3). Lung tissue samples were analyzed for endothelin and COX-2 levels after surgery. Results: At T3, Group P had significantly higher PaO2 and lower Qs/Qt than Groups Nand C (all p < 0.05), with no significant differences between Groups N and C (all p>0.05). Compared to T1, Groups N and C showed significantly lower PaO2 and higher Qs/Qt at T2 and T3 (all p < 0.05), with no significant differences in PaO2 and Qs/Qt at T3 compared with T2 (all p>0.05). Group P patients had lower PaO2 and higher Qs/Qt at T2 and T3 compared to T1 (all p < 0.05), but at T3, PaO2 increased and Qs/Qt decreased compared to T2 (all p < 0.05). Lung tissue levels of endothelin and COX-2 were significantly elevated in group P compared to groups N and C (all p < 0.05). Conclusion: Combining phenylephrine with restrictive infusion during OLV improved oxygenation by increasing PaO2, decreasing Qs/Qt, and raising endothelin and COX-2 levels in lung tissue, thereby enhancing the HPV effect. KEY MESSAGES 1. Phenylephrine with restrictive infusion improves oxygenation during one-lung ventilation by increasing PaO2 and reducing Qs/Qt. 2. The mechanism may involve the specific upregulation of pulmonary endothelin and cyclooxygenase-2 levels by phenylephrine, enhancing hypoxic pulmonary vasoconstriction. Introduction ARTICLE HISTORY Received 18 April 2025 Revised 13 November 2025 Accepted 29 December 2025 KEYWORDS Hypoxia; one-lung ventilation; norepinephrine; phenylephrine; oxygenation; intrapulmonary shunt One-lung ventilation (OLV) involves the selective ventilation of a single lung and is a prevalent technique in thoracic surgery. This method isolates the diseased lung to prevent infection of the healthy lung, thereby reducing complications and enhancing the surgical field of view [1,2] . During OLV, thenon-dependent lung remains unventilated while continuous blood flow persists through it. This results in the admixture of unoxygenated venous blood with oxygenated alveolar capillary blood, which is subsequently introduced into the arterial circulation. Consequently, this leads to venous blood adulteration CONTACT Yongzhe liu [yongzhe_lucy@hotmail.com](yongzhe_lucy@hotmail.com) department of Anesthesiology, The Third Medical center of PlA General Hospital, Beijing, china. supplemental data for this article can be accessed online at [https://doi.org/10.1080/07853890.2025.261](https://doi.org/10.1080/07853890.2025.261)1655. © 2026 The Author(s) . Published by informa UK limited, trading as Taylor & francis Group This is an open Access article distributed under the terms of the creative commons Attribution-noncommercial license ([http://creativecommons.org/licenses/](http://creativecommons.org/licenses/)[ ](http://creativecommons.org/licenses/)[by-nc/4.0/](by-nc/4.0/)), which pe

FAQs

What was the main objective of this study during one-lung ventilation?

To compare how norepinephrine or phenylephrine combined with restrictive infusion affected oxygenation during thoracoscopic one-lung ventilation.

How were oxygenation and shunt fraction evaluated across the study groups?

PaO2 and Qs/Qt were measured in lateral positions during two-lung ventilation at 10 minutes, and during one-lung ventilation at 15 and 45 minutes.

What did the study find about phenylephrine versus the other groups at 45 minutes of OLV?

At 45 minutes, the phenylephrine group showed higher PaO2 and lower Qs/Qt than the norepinephrine and control groups, with no significant difference between norepinephrine and control.

Sep 30, 2026

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