title: Prevention of overlooked bullae during video-assisted thoracic surgery (VATS) with a combination of high frequency jet ventilation (HFJV) and positive end-expiratory pressure (PEEP) for spontaneous pneumothorax.
abstract: BACKGROUND
  Overlooked bullae have been reported to contribute to the higher incidence of recurrence of pneumothorax following video-assisted thoracic surgery (VATS). In this study, we investigated whether high frequency jet ventilation (HFJV) + positive end-expiratory pressure (PEEP) prevented overlooking of bullae by blowing up the bullae and inflating the lungs moderately during VATS for spontaneous pneumothorax patients.
  
  
  METHODS
  A total of 31 patients with spontaneous pneumothorax who underwent VATS were enrolled in this study. We examined the number, size, and location of bullae with and without HFJV+PEEP during VATS.
  
  
  RESULTS
  More bullae were found with HFJV + PEEP than without HFJV + PEEP in 15 of the 31 patients. Significantly more bullae smaller than 2 cm in diameter were detected with HFJV + PEEP than without HFJV + PEEP. In the patients with 1 - 3 bullae, the detection rate was significantly higher with HFJV + PEEP than without HFJV + PEEP. All bullae confirmed with VATS were detected only in one case (3.2 %) on preoperative chest X-ray, and in two cases (6.5 %) on chest CT. The recurrence rate of pneumothorax following VATS with HFJV + PEEP was 3.3 % (1/31).
  
  
  CONCLUSIONS
  Our results suggested that VATS combined with HFJV and PEEP might prevent the overlooking of bullae and reduce the postoperative recurrence of spontaneous pneumothorax.
authors.affiliation: Department of Molecular Biology, Osaka Bioscience Institute, Suita City, Osaka, Japan.
authors.forename: E
authors.initials: E
authors.lastname: Ogawa
authors.forename: K
authors.initials: K
authors.lastname: Takenaka
authors.forename: F
authors.initials: F
authors.lastname: Kawashita
authors.forename: S
authors.initials: S
authors.lastname: Moriyama
authors.forename: T
authors.initials: T
authors.lastname: Hirata
mesh_terms: D000293:Adolescent; D000328:Adult; D001768:Blister / Q000175:diagnosis*; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006611:High-Frequency Jet Ventilation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000517:prevention & control*; D011175:Positive-Pressure Respiration / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control*; D055502:Secondary Prevention; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*