The Effets of Independent Lung Ventilation with Unilateral HFJV and CPAP

Effects of Nondependent Lung Ventilation With Continuous Positive-Pressure Ventilation and High-Frequency Positive-Pressure Ventilation on Right-Ventricular Function During 1-Lung Ventilation

“…In our study, the commencement of nondependent HFPPV after 1-lung ventilation improved REF by 33% and arterial oxygenation and reduced shunt fraction by 24.8% as compared with the CPAP groups, which may be secondary to the concurrent increases in CI and SVI and reductions in PVRI and RVEDVI attributable to the recruitment of the atelectatic NL. Similarly, the application of either high-frequency percussive ventilation 24 or HFJV 8,10 to the NL during 1-lung ventilation improved oxygenation in comparison with the use of nondependent CPAP.…”

“…[1][2][3][4][5] The application of HFJV or CPAP to the NL during OLV improves the arterial oxygen tension and saturation and reduces shunt fraction. [6][7][8][9][10] We reported improved right-ventricular function, CI, arterial oxygenation, and surgical field and reduced shunt fraction after the application of volume-controlled HFPPV to the NL during OLV for thoracic surgery.…”

“…[1][2][3][4][5] There are different approaches for the recruitment of the nondependent lung (NL) during OLV such as the selective application of continuous positive-pressure ventilation (CPAP) or high-frequency jet ventilation (HFJV) to the NL. [6][7][8][9][10] These recruitment strategies may improve arterial oxygenation and reduce shunt fraction, [6][7][8][9][10] Although CPAP maintains the patency of alveoli to oxygenate the shunted blood to the NL, it may concurrently increase pulmonary vascular resistance through the diversion of blood to the dependent ventilated lung and even decrease cardiac output; therefore, it may have contradictory effects on overall right-ventricular function. 11,12 Others found that NL-HFJV was more effective than NL-CPAP in improving oxygenation, reducing intrapulmonary shunt, and recruiting the small airway closure.…”

“…11,12 Others found that NL-HFJV was more effective than NL-CPAP in improving oxygenation, reducing intrapulmonary shunt, and recruiting the small airway closure. 10 However, the use of HFJV may be associated with gas trapping secondary to increases in ventilatory frequency, which may result in an increase in right-ventricular afterload and impairment of right-ventricular function. 13 Therefore, the use of 2-lung high-frequency positivepressure ventilation (HFPPV) using tidal volumes just greater than the dead space has some advantages over the NL CPAP during OLV, including better arterial oxygenation, lower airway pressures, and adequate surgical exposure, and is devoid of any undesirable physiological disturbances.…”