High-frequency jet ventilation as an alternative method compared to conventional one-lung ventilation using double-lumen tubes during minimally invasive coronary artery bypass graft surgery.
OBJECTIVE
To optimize the conditions for the surgeon during minimally invasive direct coronary artery bypass (MIDCAB) and totally endoscopic coronary artery bypass (TECAB) procedures, one-lung ventilation (OLV) is required using double-lumen tubes (DLT). This prospective study was designed to compare high-frequency jet ventilation (HFJV) of both lungs with the conventional method of OLV via DLT.


METHODS
Prospective, randomized, clinical study.


METHODS
University-affiliated heart center.


METHODS
Forty patients with coronary artery disease and scheduled for elective MIDCAB or TECAB procedures were equally randomized into a DLT and an HFJV group.


METHODS
In the DLT group, OLV of the right lung was performed throughout the surgical procedure. In the HFJV group, patients received a conventional single-lumen endotracheal tube and both lungs were ventilated using HFJV.


METHODS
Hemodynamic, oxygenation and ventilation parameters were measured at the beginning of the operation, then 5, 15, 30, and 60 minutes after OLV/HFJV, as well as immediately before transfer to the ICU.


RESULTS
Regarding the view of the surgical field, surgeons' comfort did not differ between methods. The intraoperative PaO(2) was significantly higher in the HFJV group compared with the DLT group at 5 (336.8 +/- 123.3 v 228.6 +/- 124.0; p = 0.009) and 15 minutes (301.7 +/- 133.9 v 192.6 +/- 92.8; p = 0.012). The PaCO(2) was significantly higher in the HFJV group after 5 minutes and persisted through 60 minutes of ventilation. The peak inspiratory pressure was significantly lower during HFJV (10.0 +/- 2.8 mbar v 32.1 +/- 5.9 mbar).


CONCLUSIONS
HFJV in MIDCAB or TECAB procedures appears to be a feasible alternative to OLV using a DLT, although study in a larger population is required.
Ender
Joerg
J
Department of Anesthesiology and Intensive Care Medicine II, Heartcenter, University of Leipzig, Leipzig, Germany. joerg.ender@medizin.uni-leipzig.de
Brodowsky
Magdalena
M
Falk
Volkmar
V
Baunsch
Joergen
J
Koncar-Zeh
Jasmina
J
Kaisers
Udo X
UX
Mukherjee
Chirojit
C
D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006611:High-Frequency Jet Ventilation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods