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Comparison of double-lung jet ventilation and one-lung ventilation for thoracotomy

Published online by Cambridge University Press:  01 January 2008

H. Misiolek ,
P. Knapik ,
J. Swanevelder ,
R. Wyatt  and
M. Misiolek
H. Misiolek*
Affiliation:
Medical University of Silesia, Department of Anaesthesia and Intensive Care, Katowice, Poland
P. Knapik
Affiliation:
Medical University of Silesia, Department of Anaesthesia and Intensive Care, Katowice, Poland
J. Swanevelder
Affiliation:
University Hospitals of Leicester NHS Trust, Glenfield Hospital, Department of Cardiothoracic Anaesthesia, Leicester, UK
R. Wyatt
Affiliation:
University Hospitals of Leicester NHS Trust, Glenfield Hospital, Department of Cardiothoracic Anaesthesia, Leicester, UK
M. Misiolek
Affiliation:
Medical University of Silesia Katowice, Department of ENT, Poland
*
Correspondence to: Hanna Misiolek, Department of Anaesthesia and Intensive Care, Medical University of Silesia, 41-800 Zabrze, ul. 3 Maja 13/15, Poland. E-mail: katanestz@slam.katowice.pl; Tel/Fax: +48 323 701 617
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Summary

Background and objective

Thoracic surgery requires immobilization of the operating area. Usually, this is achieved with one-lung ventilation (OLV), however this may still lead to some movement. High-frequency jet ventilation (HFJV) may be an alternative way of ventilation in thoracic surgery. The purpose of this study was to determine the effectiveness of HFJV as an alternative option to OLV for thoracic procedures.

Methods

Sixty patients were randomized to receive either HFJV (n = 29) or OLV (n = 31) during the operation. During the course of the study 10 patients were excluded (4 patients in HFJV group and 6 patients in OLV group). The following haemodynamic and ventilatory parameters were recorded: heart rate, systolic and mean blood pressure, ventricular stroke volume, cardiac index, systemic vascular resistance, peak inspiratory pressure, oxygen saturation, PaO2 and PaCO2. Overall parameters were documented before the initiation of the chosen mode of ventilation every 15 min during the operation.

Results

Patients in both groups showed comparable cardiovascular function. Mean values of peak inspiratory pressure were significantly higher in the OLV group. Oxygen saturation values were statistically higher in the HFJV group. PaCO2 values were similar in both during surgery, but were higher in the OLV group after awakening. Mean values of shunt fraction were lower in the HFJV group. Lower values of peak inspiratory pressure were therefore associated with higher partial pressure of carbon dioxide levels in the HFJV group. In the OLV group, 44% of patients experienced a postoperative sore throat. Operating conditions were comparable.

Conclusion

HFJV is safe option, comparable to OLV and offers some advantages for open-chest thoracic procedures.

Keywords

HIGH-FREQUENCY JET VENTILATIONMECHANICAL VENTILATION, one lungANAESTHESIA GENERALTHORACIC SURGERYPULMONARY GAS EXCHANGE
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 1 , January 2008 , pp. 15 - 21
Copyright
Copyright © European Society of Anaesthesiology 2007

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References

1.Chow, MY, Goh, MH, Ti, LK. Predicting the depth of insertion of left-sided double-lumen endobronchial tubes. J Cardiothorac Vasc Anesth 2002; 16: 456–458.CrossRefGoogle ScholarPubMed
2.JrLewis, JW, Serwin, JP, Gabriel, FS et al. . The utility of a double-lumen tube for one-lung ventilation in a variety of noncardiac thoracic surgical procedures. J Cardiothorac Vasc Anesth 1992; 6: 705–710.CrossRefGoogle Scholar
3.Kaplan, JA. Lung separation techniques. In: Thoracic Anesthesia Churchill Livingstone An Imprint of Elsevier Science (USA) Philadelphia 2003; 159–164.Google Scholar
4.Cohen, E. One lung ventilation: prospective from an interested observer. Minerva Anesthesiol 1999; 65: 275–283.Google ScholarPubMed
5.Wagner, DL, Gammage, GW, Wong, ML. Tracheal rupture following the insertion of a disposable double-lumen endotracheal tube. Anesthesiology 1985; 63: 698–700.CrossRefGoogle ScholarPubMed
6.Balci, AE, Eren, N, Eren, S et al. . Surgical treatment of post-traumatic tracheobronchial injuries: 14-year experience. Eur J Cardiothorac Surg 2002; 22: 984–989.CrossRefGoogle Scholar
7.Dal Corso, B, Tanaskovic, G, Mastropasqua, D et al. . Iatrogenic rupture of the left mainstem bronchus in tracheobronchial intubation. Minerva Anestesiol 1998; 64: 581–585.Google ScholarPubMed
8.Hofmann, HS, Rettig, G, Radke, J et al. . Iatrogenic ruptures of the tracheobronchial tree. Eur J Cardiothorac Surg 2002; 21: 649–652.CrossRefGoogle ScholarPubMed
9.Lanzenberger-Schragl, E, Donner, A, Grasl, MC et al. . Superimposed high-frequency jet ventilation for laryngeal and tracheal surgery. Arch Otolaryngol Head Neck Surg 2000; 126: 40–44.CrossRefGoogle ScholarPubMed
10.Blomquist, S, Algotsson, L, Karlsson, SE. Anaesthesia for resection of tumours in the trachea and central bronchi using the Nd-YAG-laser technique. Acta Anaesthesiol Scand 1990; 34: 506–510.CrossRefGoogle ScholarPubMed
11.Magnusson, L, Lang, FJ, Monnier, P et al. . Anaesthesia for tracheal resection: report of 17 cases. Can J Anaesth 1997; 44: 1282–1285.CrossRefGoogle ScholarPubMed
12.Biro, P, Layer, M, Becker, HD et al. . Influence of airway-occluding instruments on airway pressure during jet ventilation for rigid bronchoscopy. Br J Anaesth 2000; 85: 462–465.CrossRefGoogle ScholarPubMed
13.Frietsch, T, Krafft, P, Becker, HD et al. . Intermittent capnography during high-frequency jet ventilation for prolonged rigid bronchoscopy. Acta Anaesthesiol Scand 2000; 44: 391–397.CrossRefGoogle ScholarPubMed
14.Biro, P, Layer, M, Wiedemann, K et al. . Carbon dioxide elimination during high-frequency jet ventilation for rigid bronchoscopy. Br J Anaesth 2000; 84: 635–637.CrossRefGoogle ScholarPubMed
15.Dikmen, Y, Aykac, B, Erolcay, H. Unilateral high frequency jet ventilation during one-lung ventilation. Eur J Anaesthesiol 1997; 14: 239–243.CrossRefGoogle ScholarPubMed
16.Otto, CW, Quan, SF, Conahan, TJ et al. . Hemodynamic effects of high-frequency jet ventilation. Anesth Analg 1983; 62: 298–304.CrossRefGoogle ScholarPubMed
17.Thompson, BT, Hayden, D, Matthay, MA. Clinicians approaches to mechanical ventilation in acute lung injury and ARDS. Chest 2001; 120: 1622–1627.CrossRefGoogle ScholarPubMed
18.Bromage, PR. Epidural Analgesia. Philadelphia: WB Saunders, 1978: 458–460.Google Scholar
19.Garutti, I, Quintana, B, Olmedilla, L, Cruz, A, Barranco, M, Garcia de Lucas, E. Arterial oxygenation during one-lung ventilation: combined versus general anesthesia. Anesth Analg 1999; 88: 494–499.CrossRefGoogle ScholarPubMed
20.Kaplan, JA. Physiology of the lateral decubitus position, the open chest, and one-lung ventilation. In: Thoracic Anesthesia Churchill Livingstone An Imprint of Elsevier Science (USA) Philadelphia 2003; 71–90.Google Scholar
21.Saito, M, Cho, S, Morooka, H et al. . Effects of sevoflurane compared with those of isoflurane on arterial oxygenation and hemodynamics during one-lung ventilation. J Anesth 2000; 14: 1–5.CrossRefGoogle ScholarPubMed
22.Akata, T, Noda, Y, Takahashi, S. Effects of changes in frequency and inspiratory time on arterial oxygenation and CO2 elimination during high-frequency jet ventilation in a child with laryngotracheal papillomata. Acta Anaesthesiol Scand 2001; 45: 790–792.CrossRefGoogle Scholar
23.Nestorowicz, A, Powala-Niedzwiecki, K. Badania porównawcze układu krążenia w warunkach wentylacji insuflacyjnej z dużą częstotliwością i wentylacji z dodatnim ciśnieniem w fazie wdechu. Pol Tyg Lek 1989; 44: 142–143.Google Scholar
24.Nevin, M, Van Besouw, JP, Williams, CW et al. . A comparative study of conventional versus high-frequency jet ventilation with relation to the incidence of postoperative morbidity in thoracic surgery. Ann Thorac Surg 1987; 44: 625–627.CrossRefGoogle Scholar
25.Della Rocca, G, Pompei, L, Coccia, C et al. . Anesthesia for lung volume reduction surgery. Minerva Anestesiol 2001; 67: 3713–3780.Google ScholarPubMed
26.Carlon, GC, Kahn, RC, Howland, WS et al. . Clinical experience with high frequency jet ventilation. Crit Care Med 1981; 9: 1–6.CrossRefGoogle ScholarPubMed
27.Howland, WS, Carlon, GC, Goldiner, PL et al. . High-frequency jet ventilation during thoracic surgical procedures. Anesthesiology 1987; 67: 1009–1012.CrossRefGoogle ScholarPubMed
28.Lanzenberger-Schragl, E, Donner, A, Kashanipour, A et al. . High frequency ventilation techniques in ARDS. Acta Anaesthesiol Scand Suppl 1996; 109: 157–161.Google ScholarPubMed
29.Schragl, E, Donner, A, Kashanipour, A et al. . Erste Erfahrungen mit der Superponierten Hochfrequency Jet-Ventilation in der Intensivmedizin. Anaesthesist 1995; 44: 429–435.CrossRefGoogle Scholar
30.Fusciardi, J, Rouby, JJ, Barakat, T et al. . Hemodynamic effects of high-frequency jet ventilation in patients with and without circulatory shock. Anesthesiology 1986; 65: 485–491.CrossRefGoogle ScholarPubMed
31.Normandale, J, Patrick, M, Sherry, KM et al. . Comparison of conventional intermittent positive pressure ventilation with high frequency jet ventilation. Studies following aortocoronary bypass graft surgery. Anaesthesia 1987; 42: 824–834.CrossRefGoogle ScholarPubMed
32.Herridge, M, Slutsky, A. High-frequency ventilation: a ventilatory technique that merits revisiting. Respir Care 1996; 41: 385–394.Google Scholar
33.Ender, J, Panzer, M, Gummert, J et al. . High frequency jet ventilation for minimally invasive coronary artery bypass operation. Anasthesiol Intensivmed 2002; 43: 529.Google Scholar
34.Conacher, ID, Herrema, IH, Batchelor, AM. Robertshaw double lumen tubes: a reappraisal thirty years on. Anaesth Intensive Care 1994; 22: 179–183.CrossRefGoogle Scholar