Einseitige High-Frequency-Jet-Ventilation als Ergänzung der Ein-Lungenbeatmung bei thoraxchirurgischen Eingriffen

Abstract

We report two cases where surgery on the right lung had to be performed for resection of a malignoma. In both cases, function of the left lung was severely restricted. In the first patient, the volume on this side was reduced by around 50% as the result of a recently performed upper lobe resection. In the second patient, perfusion of the left lung accounted for only 18% of the total lung perfusion. On the basis of these changes we considered conventional one-lung ventilation impracticable and performed surgery using differential lung ventilation. The dependent (left) lung was ventilated by intermittent positive pressure ventilation (IPPV), where the tidal volume in the first patient had to be reduced to 200 ml because of high airway pressures. Ventilation of the non-dependent (right) side was performed simultaneously in both patients by means of high frequency jet ventilation (HFJV). Under this procedure arterial O2 saturation ranged from 96 to 100%, and arterial CO2 partial pressure was 45 mmHg. Surgery was not hindered by ventilation, the postoperative progress was also without complications. The case reports show that with the help of the ventilation regime described (operated side: HFJV, non-operated side: IPPV) lung surgery can be successfully performed on patients who are unsuitable for conventional one-lung ventilation for functional reasons.

Sekundäre Lungeneingriffe nach vorausgegangener kontralateraler Pneumonektomie

“…Ausgesprochen nützlich ist dieses Vorgehen vor allem dann, wenn eine massive Funktionseinschränkung der unten liegenden (abhängigen) Lunge besteht, z. B. nach der Resektion von Lungengewebe oder aufgrund einer schweren Perfusionsstörung [12]. Die Extremvariante einer solchen Situation stellt der Patient dar, bei dem die unten liegende Lunge infolge einer zuvor durchgeführten Pneumonektomie fehlt.…”