Porównanie dwóch metod wentylacji płuc podczas zabiegów wewnątrz klatki piersiowej

© Borgis - Anestezjologia Intensywna Terapia 2/2006, s. 66-71

*Hanna Misiołek1, Piotr Knapik1, Wojciech Rokicki2, Hanna Kucia1, Grzegorz Bujok1, Mieczysław Dziedzic2

Summary
Background.Thoracic surgery requires both effective ventilation and immobilisation of the operating area. Usually, this is achieved with the insertion of a double lumen tube and one lung ventilation (OLV), however this may lead to several haemodynamic and respiratory disturbances. High frequency ventilation (HFV) may be considered as an alternative means of ventilation during lung resection.
Methods. The purpose of this study was to compare selected haemodynamic and ventilatory parameters during HFV (200 bpm, FIO2 1.0) or OLV (VT 8-10 ml kg-1, f 12/min, FIO2 1.0) during open-chest surgery. 56 adult ASA II and III patients, of both sexes, were randomised to receive either double-lung HFV (n=25) or OLV (n=25). Heart rate, systolic, diastolic and mean blood pressures, ventricular stroke volume, peak inspiratory pressures, oxygen saturation, PaO2 and PaCO2 were noted. Additionally, cardiac index (CI) and shunt fraction (Qs/Qt ) were calculated.
Results. Gas exchange: SaO2 was significantly higher in the HFV group. PaCO2 was significantly higher in the second part of the surgery in the HFV group; hypercapnia was noted in the both groups. Qs/Qt was significantly higher in the OLV patients. Peak inspiratory pressures were lower in the HFV group.
Haemodynamics: All measured data were similar in both groups, apart from SV, which decreased significantly at the end of surgery in the OLV group. There was a high positive correlation between hypercapnia and HR in the botu groups and a high negative correlation between peak inspiratory pressure and MPA in OLV group.
Discussion and conclusion. It appears that HFV may be superior to OLV in thoracic surgery in selected procedures when complete collapse of the lung is not required. Effective gas exchange, better haemodynamics, and safety should encourage the use of HFV in this kind of surgery.

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