One-Lung Ventilation, Thoracic Surgery, Video-Assisted
Conditions
Keywords
Hypoxia, High-Frequency Jet Ventilation, Continuous Positive Airway Pressure
Brief summary
This study compares two ventilatory techniques (continuous positive airway pressure vs high frequency jet ventilation) during one-lung ventilation (OLV) in video-assisted thoracic surgery (VATS). All patients were ventilated with both ventilatory techniques and parameters of gas exchange were determined through arterial blood gas test.
Detailed description
One-lung ventilation is mandatory during most thoracic surgery procedures. During OLV, collapsed lung develops an intrapulmonary shunt leading to arterial hypoxemia. Since arterial hypoxemia is a critical intraoperative problem, many times , anesthesiologists have to use rescue ventilation strategies on non-dependent lung to improve arterial oxygen levels. The use of continuous positive airway pressure on non-dependent lung has become the most common technique to achieve that aim. High-frequency jet ventilation on non-dependent lung may be considered as an alternative way of ventilation of the non-dependent lung during one-lung ventilation because it provides a suitable gaseous exchange while facilitating minimizing surgical field motion. However, this ventilation maneuver is rarely use by thoracic anesthesiologists. Over the last years, video assisted thoracic surgery (VATS) has become widely utilized. This surgical technique becomes even more dependent on immobilization of the operation field than open-chest thoracic procedures. There is a lack of evidence in the current literature regarding the use of HFJV in VATS. The purpose of this study is to evaluate the effects of HFJV as an alternative for the treatment of hypoxemia in VATS. One-lung ventilation is mandatory during most thoracic surgery procedures. During OLV, collapsed lung develops an intrapulmonary shunt leading to arterial hypoxemia. Since arterial hypoxemia is a critical intraoperative problem, many times , anesthesiologists have to use rescue ventilation strategies on non-dependent lung to improve arterial oxygen levels. The use of continuous positive airway pressure on non-dependent lung has become the most common technique to achieve that aim. High-frequency jet ventilation on non-dependent lung may be considered as an alternative way of ventilation of the non-dependent lung during one-lung ventilation because provide suitable gaseous exchange while facilitate minimizing surgical field motion. However , this ventilation maneuver is rarely use by thoracic anesthesiologists. Over the last years, video assisted thoracic surgery (VATS) has become widely utilized. This surgical technique becomes even more dependent on immobilization of the operation field than open-chest thoracic procedures. There is a lack of evidence in the current literature about the use of HFJV in VATS. The purpose of this study is to evaluate the effects of HFJV as an alternative for the treatment of hypoxemia in VATS.
Interventions
PROCEDURECPAP
A recruitment maneuver will be applied to the ventilated lung. Immediately continuous positive airway pressure, at a pressure of 2-3cmH2O will applied to the non-ventilated lung for 20 minutes by the Mallinckrodt Bronchocath Disposable CPAP system (a recognised anesthetic breathing system design for CPAP).
PROCEDUREHFJV
A recruitment maneuver will be applied to the ventilated lung. Immediately, high-frequency jet ventilation, with a driving pressure of 0.5 atm and a respiratory rate of 100 cycles per minute will applied to the non-ventilated lung for 20 minutes using the Monsoone III Jet Ventilator (Acutronic, Hirzel, Switzerland). Monsoone III is a recognised ventilator design for HFJV.
Sponsors
Hospital General Universitario de Alicante
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
SUPPORTIVE_CARE
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Subject requiring one-lung ventilation * Subject under video-assisted thoracic surgery
Exclusion criteria
* Pregnant * Emergent surgery * Hemodynamic instability
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| PaO2/FiO2 | 1 day | Ratio of the arterial oxygen partial pressure (PaO2) to the inspired oxygen fraction (FiO2) determination. Time 0 (the patient is anesthetized and being ventilated on two lungs). Time 20 minutes (patient has been ventilated on one lung for 20 minutes). Time 40 minutes (following a period of 20 minutes on one intervention arm \[either CPAP or HFJV\]. The patient will then enter second intervention arm). Time 60 minutes ( 20 minutes after second intervention arm \[either CPAP or HFJV\]) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| PaCO2 | 1 day | Arterial carbon dioxide partial pressure determination. Time 0 (the patient is anesthetized and being ventilated on two lungs). Time 20 minutes (patient has been ventilated on one lung for 20 minutes). Time 40 minutes (following a period of 20 minutes on one intervention arm \[either CPAP or HFJV\]. The patient will then enter second intervention arm). Time 60 minutes ( 20 minutes after second intervention arm \[either CPAP or HFJV\]) |
| Operative field conditions | 1 day | Surgeon's subjective opinion about operating conditions during the interventions: impossible surgical access, acceptable operative filed or excellent operative field). Time 20 minutes (patient has been ventilated on one lung for 20 minutes). Time 40 minutes (following a period of 20 minutes on one intervention arm \[either CPAP or HFJV\]. The patient will then enter second intervention arm). Time 60 minutes ( 20 minutes after second intervention arm \[either CPAP or HFJV\]) |
Other
| Measure | Time frame | Description |
|---|---|---|
| Airway pressures | 1 day | Recording during mechanical ventilation of dependent lung airway pressures. Time 0 (the patient is anesthetized and being ventilated on two lungs). Time 20 minutes (patient has been ventilated on one lung for 20 minutes). Time 40 minutes (following a period of 20 minutes on one intervention arm \[either CPAP or HFJV\]. The patient will then enter second intervention arm). Time 60 minutes ( 20 minutes after second intervention arm \[either CPAP or HFJV\]) |
| Adverse effects and complication | 30 days | Any complication or adverse effect arising from ventilation techniques: need of intensive care unit admissions, re-intervention, or thoracotomy, surgical site infection, anastomosis leakage, and pneumonia. |
| Hemodynamic parameters | 1 day | Heart rate and mean arterial blood pressure. Time 0 (the patient is anesthetized and being ventilated on two lungs). Time 20 minutes (patient has been ventilated on one lung for 20 minutes). Time 40 minutes (following a period of 20 minutes on one intervention arm \[either CPAP or HFJV\]. The patient will then enter second intervention arm). Time 60 minutes ( 20 minutes after second intervention arm \[either CPAP or HFJV\]) |
Countries
Spain
Outcome results
None listed