A new clinical sign during one‐lung anaesthesia: fact or fiction?

Pfitzner, J.

doi:10.1111/j.1365-2044.2002.2520_18.x

Cited by 3 publications

(1 citation statement)

References 7 publications

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“…First, the cyclical distension and collapse of the connected reservoir bag serves as visual confirmation of the presence and magnitude of the tidal gas movement in a given patient 4,[21][22][23] . Second, its use enables the reliable and early identification of both small and larger volume gas leakage past the bronchial cuff, with a large leak resulting in a progressive expansion of the reservoir bag over a number of ventilations 4 , while a small gas leak can be identified by pressing an ear against the reservoir bag to hear the unmistakeable sound of gas escaping past a tight restriction 4,24 . This effective auditory conduit to the airways of both the non-ventilated and the ventilated lung also enables identification of imminent displacement of the DLT caused by surgical traction at the pulmonary hilum during a thoracotomy 25 .…”

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The role of an ambient pressure oxygen source during one-lung ventilation for thoracoscopic surgery

Pfitzner

2016

Anaesth Intensive Care

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Video-assisted thoracoscopic surgery is facilitated by prompt collapse of the non-ventilated (‘operated’) lung, and interrupted and impeded if there is a need for oxygen (O2) delivery by continuous positive airways pressure in order to manage hypoxaemia. It has been proposed that connecting an ambient pressure O2 source to the airway of the non-ventilated lung at the time one-lung ventilation is initiated and before the chest is opened will, by avoiding entrainment of ambient nitrogen, serve to facilitate lung collapse. It has also been proposed that leaving the O2 source connected will enable, not only ongoing apnoeic oxygenation before the chest is opened, but also the thoracoscopic procedure to commence with the operated lung fully pre-oxygenated (with an inspired oxygen fraction of 1), and apnoeic oxygenation to continue throughout the operative procedure in those patients who exhibit a degree of small airways patency at ambient pressure. In reality, several factors can influence the speed of collapse of the operated lung, and very many factors can influence the incidence of hypoxaemia during one-lung ventilation. It therefore appears unlikely that the necessary evidence to support these proposals will be forthcoming from randomised clinical studies on large numbers of patients. Rather, the necessary evidence may only be provided by specifically designed within-patient clinical measurement studies. Nevertheless, it is argued that, in the meantime, there is already sufficient rationale for an ambient pressure O2 source to be connected to the airway of the non-ventilated lung, and for it to remain connected for the duration of one-lung ventilation.

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