APPLICATION OF ONE-LUNG HIGH FREQUENCYAPPLICATION OF ONE-LUNG HIGH FREQUENCY JET VENTILATIONJET VENTILATION IN LUNG SURGERYIN LUNG SURGERYM. Kontorovich, M. Kontorovich, S. Skornyakov, S. Skornyakov, I. Medvinsky, I. Medvinsky, I. Motus, I. Motus, D. EremeevD. Eremeev

Ural Research Institute for PhthiziopulmonologyUral Research Institute for Phthiziopulmonology

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IntroductionIn the present day, one-lung jet ventilation is applied in case of a necessity to isolate the 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 healthy lung during operations involving abscedation, occurrence of fluid buildings, cysts or retrostenosis pneumonitis in the operated lung (1,2).retrostenosis pneumonitis in the operated lung (1,2).

Apart from complications linked to usage of endotra-heal tubes, accompanying symptoms of Apart from complications linked to usage of endotra-heal tubes, accompanying symptoms of convective one-lung ventilation include considerably decreased diffusion in surface area, sharp convective one-lung ventilation include considerably decreased diffusion in surface area, sharp increase in intrapulmonary arteriovenous blood circulation, increase in transpulmonary pressure, increase in intrapulmonary arteriovenous blood circulation, increase in transpulmonary pressure, decrease in venous return and cardiac output, increase in amount of extravascular lung water decrease in venous return and cardiac output, increase in amount of extravascular lung water (3,5).(3,5).

All this can lead to decrease in oxygenation of arterial blood, development of an uncorrectable All this can lead to decrease in oxygenation of arterial blood, development of an uncorrectable hypoxia, disorders of central hemodynamics and development of post-surgery complications hypoxia, disorders of central hemodynamics and development of post-surgery complications (4,5,6).(4,5,6).

At the same time, a number of authors consider application of high frequency jet ventilation At the same time, a number of authors consider application of high frequency jet ventilation during lung surgeries to be without any alternative (1,2,5). 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 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 venous return and relaxed state without execution of a recruitment maneuver and increases venous return and cardiac output by lowering the workload of the left ventricle (2,6,7). cardiac output by lowering the workload of the left ventricle (2,6,7).

MethodsConclusions

In comparison of OHFJV to OCMV, the results of the study demonstratedIn comparison of OHFJV to OCMV, the results of the study demonstrated a a decrease of: PIP – by 26.5%; Pes – by 81.6%; PVR – by 41.7%, an decrease of: PIP – by 26.5%; Pes – by 81.6%; PVR – by 41.7%, an increase of: PaOincrease of: PaO2 2 –– by 66.1%; CI – by 1.0%; CVP – by 28.3% by 66.1%; CI – by 1.0%; CVP – by 28.3% and and

maintaining maintaining of of normal normal рН рН == 7.42 7.42 and and РаСО РаСО22 == 36.5 mm Hg.36.5 mm Hg.

Introduction Results

Bibliography

Under conditions of OHFJV, even a complete atelectasis of one lung does not 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. 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 This enabled a wider application of this kind of ventilation for lung surgeries on patients with distinct gas exchange and hemodynamics disorders.patients with distinct gas exchange and hemodynamics disorders.

Three groups consisting of 50 patients who under-went lung surgery during which two-lungs Three groups consisting of 50 patients who under-went lung surgery during which two-lungs conventional mechanical ventilation (CMV), one-lung conventional mechanical ventilation (OCMV) and conventional mechanical ventilation (CMV), one-lung conventional mechanical ventilation (OCMV) and one-lung high frequency jet ventilation (OHFJV) were applied, were compared in terms of gas exchange one-lung high frequency jet ventilation (OHFJV) were applied, were compared in terms of gas exchange and hemodynamics parameters.and hemodynamics parameters.

Artificial ventilation was applied through a single-lumen endotracheal tube located in the main Artificial ventilation was applied through a single-lumen endotracheal tube located in the main bronchus of the healthy lung. In case of necessity of left main bronchus intubation, a correcting triple bronchus of the healthy lung. In case of necessity of left main bronchus intubation, a correcting triple maneuver was executed. Usage of standard single-lumen endotracheal tubes ensured a good isolation of maneuver was executed. Usage of standard single-lumen endotracheal tubes ensured a good isolation of the healthy lung, facileness of sanitation and bronchoscopic control of the location of the tube.the healthy lung, facileness of sanitation and bronchoscopic control of the location of the tube.

CMVCMV OCMVOCMV OHFJVOHFJVCMVCMV OCMVOCMV OHFJVOHFJVCMVCMV OCMVOCMV OHFJVOHFJVCMVCMV OCMVOCMV OHFJVOHFJV

CMVCMV OCMVOCMV OHFJVOHFJVCMVCMV OCMVOCMV OHFJVOHFJV

CMVCMV OCMVOCMV OHFJVOHFJVCMVCMV OCMVOCMV OHFJVOHFJV CMVCMV OCMVOCMV OHFJVOHFJVCMVCMV OCMVOCMV OHFJVOHFJV CMVCMV OCMVOCMV OHFJVOHFJVCMVCMV OCMVOCMV OHFJVOHFJV

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