Use of the Ventrain Ventilation Device and an Airway Exchange Catheter to Manage Hypoxemia During Thoracic Surgery and One-Lung Ventilation

Abstract

HYPOXEMIA is a common challenge during one-lung ventilation (OLV), 1,2 and first-line approaches for its management include assessing airway device position, increasing oxygeninspired fraction (FIO 2 ), optimizing ventilation, and applying continuous positive airway pressure to the nonventilated lung. 3,4 The Ventrain (Ventinova Medical, Eindhoven, Netherlands) allows for ventilation through smaller internal diameter endotracheal tubes or smaller bore catheters. It is a handheld device with tubing for connection to an oxygen flow meter on one end and a male Luer Lock connector on the other end. Ventilation is actuated by alternately covering and uncovering the exhaust hole with the operator's thumb. On exhalation, the device design exploits the Venturi effect to generate negative pressure and active expiration phase. Ventrain has been used in patients with critical airway narrowing or patients in extremis as a result of failed airway management. [5][6][7][8][9] Fig 1. The anesthesia monitor showing the curves during manual ventilation of the right lung using the Ventrain device connected to the airway exchange catheter. FIO 2 and end-tidal CO 2 (ETCO 2 ) values were measured from the Ventrain-dedicated port. The low ETCO 2 peak during the inspiration phase probably was due to the flow from the Ventrain to the airway exchange catheter after occlusion of the expiration port. Pressure, flow, and volume curves are related to the mechanically ventilated left lung.