This document describes a study comparing the effects of different ventilation techniques during lung surgery. Three groups of 50 patients each underwent lung surgery using either two-lung conventional mechanical ventilation, one-lung conventional ventilation, or one-lung high frequency jet ventilation. The results showed that one-lung high frequency jet ventilation significantly improved blood oxygen levels and cardiac output while lowering pressures and pulmonary vascular resistance compared to one-lung conventional ventilation. This technique allowed for better gas exchange and hemodynamics even with complete collapse of one lung.

1. APPLICATION OF ONE-LUNG
HIGH FREQUENCY
JET VENTILATION
IN LUNG SURGERY
M. Kontorovich, B. Zislin
Ural Research Institute for Phthiziopulmonology
Yekateriburg
Russian Federation
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2. INTRODUCTION.
In the present day, one-lung jet ventilation is applied
in case of a necessity to isolate the healthy lung during
operations involving abscedation, occurrence of fluid
buildings, cysts or retrostenosis pneumonitis in the
operated lung (1,2).
Apart from complications linked to usage of endotra-
cheal tubes, accompanying symptoms of convective
one-lung ventilation include considerably decreased dif-
fusion in surface area, sharp increase in intrapulmonary
arteriovenous blood circulation, increase in transpulmo-
nary pressure, decrease in venous return and cardiac
output, increase in amount of extravascular lung water
(3,5).
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3. All this can lead to decrease in oxygenation of arte-
rial blood, development of an uncorrectable
hypoxia, disorders of central hemodynamics and
development of post-surgery complications (4,5,6).
At the same time, a number of authors consider ap-
plication of high frequency jet ventilation during lung
surgeries to be without any alternative (1,2,5).
HFJV of both lungs ensures excellent oxygenation of
arterial blood, keeps the lungs in a relaxed state without
execution of a recruitment maneuver and increases ve-
nous return and cardiac output by lowering the worklo-
ad of the left ventricle (2,6,7).
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4. METHODS.
Three groups consisting of 50 patients
who under-went lung surgery during which
two-lungs conventional mechanical ventila-
tion (CMV), one-lung conventional mecha-
nical ventilation (OCMV) and one-lung
high frequency jet ventilation (OHFJV) were
applied, were compared in terms of gas
exchange and hemodynamics parameters.
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5. Artificial ventilation was applied through a
single-lumen endotracheal tube located in the
main bronchus of the healthy lung. In case of ne-
cessity of left main bronchus intubation, a correc-
ting triple maneuver was executed. Usage of stan-
dard single-lumen endotracheal tubes ensured a
good isolation of the healthy lung, facileness of
sanitation and bronchoscopic control of the
location of the tube.
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6. RESULTS.
In comparison of OHFJV to OCMV, the
results of the study demonstrated
a decrease of: PIP – by 26.5%; Pes –
by 81.6%; PVR – by 41.7%,
an increase of: PaO2 – by 66.1%; CI – by
91.0%; CVP – by 28.3%
and maintaining of normal рН=7.42 and
РаСО2=36.5 mm Hg.
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7. РаО2 мм Hg
180 174,0 179.3
160
140
120
108,1
100
CMV OCMV OHFJV
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8. CI ml/m2/min
4
3.7
3.6
3.2
2.8
2.8
2.4 2.3
2
CMV OCMV OHFJV
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9. CVP, cm Н2О
14 13.7
13
12
11 10.4 10.7
10
9
8
CMV OCMV OHFJV
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10. PIP, cm Н2О
24
23.4
22
20
18 17.2
16 14,0
14
12
10
CMV OCMV OHFJV
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11. Рes, cm Н2О
5 4.9
4.1
4
3
2
1
0.9
0
CMV OCMV OHFJV
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12. PVR, dyn/cm5/s
2500 2381
2000 1867
1500
1388
1000
CMV OCMV OHFJV
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13. CONCLUSIONS.
Under conditions of OHFJV, even a
complete atelectasis of one lung does not
go along with a considerable disorder of
gas exchange in contrast to OCMV.
This enabled a wider application of this
kind of ventilation for lung surgeries on
patients with distinct gas exchange and
hemodynamics disorders.
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14. BIBLIOGRAPHY
K.Wiedemann, C.Mannle, M.Layer. Jet ventilation in thoracic surgery. / Anasthesiologie
1 & Intensivmedizin.-2002.-№43.-p. 527.
Б.Д. Зислин, М.Б. Конторович, А.В. Чистяков. Высокочастотная струйная
2 искусственная вентиляция лёгких / Екате­ринбург, 2010.-311 с.
P.F.Allan, E.C.Osborn, K.K.Chung [et al.]. High-frequency percus-sive ventilation revisited.
3 / J.Burn Care Res.-2010, Jul-Aug.-№ 31(4).-р.510-520.
4 L.Blanch, J.Villar, J.López-Aguilar. High-frequency percussive ventilation - an old mode
with a great future. / Crit.Care Med.-2009, May.-№37(5).- р.1810-1811
5 В.Л.Кассиль,лёгких / М.: Медицина, 2004.- 479с.
вентиляция
М.А.Выжигина, Г.С.Лескин. Искусственная и вспомогательная
H.Misiolek, P.Knapik, J.Swanevelder [et al.]. Comparison of double-lung jet ventilation
6 and one-lung ventilation for thoracotomy / Euro-pean Journal of Anaesthesiology.-
2008, Jan.-V.25.- Issue 1.-p.15-21.
H.Misiolek, P.Knapik, H.Kucia [et al.]. Haemodynamics, gas exchange and surgical
7 conditions during bilateral high frequency jet ventila-tion in lung surgery / European
Journal of Anaesthesiology.-2006, June-V.23.-Issue 7.-p.75.
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15. kombo58@mail.ru
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