Management of differential lung ventilation in thoracic surgery.

Abstract

We investigated the problems and respiratory management during DLV with Broncho -cath(R) in 24 patients undergoing thoracic surgery .There were no critical complications, but 14 of 24 patients were marked by tube troubles (58%). Tube troubles included rupture of tracheal cuff, intubation into the opposite bronchus, tube dislodgment and obstruction of tracheal lumen. So, it should always be taken care of manipulation and condition of DLT.SaO2 monitoring by pulse-oxymetry and the surveillance by bronchofiberscopy were very effective to notice tubes troubles earlily. Also, it should always be paid attention to the feeling of respiratory bag during DLV with DLT.Low PEEP or HFJV was added to the upper lung with the lower lung receiving IPPV, so that respiratory condition could be maintained almost satisfactorily. It was thought that HFJV was superior to low PEEP with regard to gas exchange. Although, low PEEP was still effective for arterial oxygenation, furthermore it could be used very easily.