title: Single-lung ventilation with carbon dioxide hemipneumothorax: hemodynamic and respiratory effects in piglets.
abstract: OBJECTIVE
  Video-assisted thoracoscopic surgery (VATS) has become a standard procedure in pediatric surgery. To facilitate surgical access, the dependent lung has to collapse using intrathoracic carbon dioxide insufflation and/or single-lung ventilation. These procedures can induce hemodynamic deteriorations in adults. The potential impacts of single-lung ventilation in combination with capnothorax on hemodynamics in infants have never been studied before.
  
  
  OBJECTIVE
  We conducted a randomized experimental study focusing on hemodynamic and respiratory changes during single-lung ventilation with or without capnothorax in a pediatric animal model.
  
  
  METHODS
  Twelve piglets were randomly assigned to receive single-lung ventilation with (SLV-CO(2) ) or without (SLV) capnothorax with an insufflation pressure of 5 mmHg for a period of two hours. Before, during, and after single-lung ventilation, hemodynamic and respiratory parameters were measured.
  
  
  RESULTS
  Although mean arterial pressure remained stable during the course of the study and no critical incidents were monitored, cardiac index (CI) decreased significantly with SLV-CO(2) (baseline 3.6 ± 1.6 l · min(-1) · m(-2) vs 2.9 ± 1.1 l · min(-1) · m(-2) at 120 min, P < 0.05). Furthermore, global end-diastolic volume and intrathoracic blood volume (ITBV) decreased as well significantly with SLV-CO(2) , causing a significant between-group difference in ITBV (P < 0.05).
  
  
  CONCLUSIONS
  Despite a decrease in CI and preload parameters, the combination of single-lung ventilation and low-pressure capnothorax was well tolerated in piglets and could justify further clinical studies to be performed in infants and children focusing on hemodynamic and respiratory changes during VATS.
authors.affiliation: Clinic of Anaesthesiology, Hannover Medical School, Hannover, Germany. witt.lars-henrik@mh-hannover.de
authors.forename: Lars
authors.initials: L
authors.lastname: Witt
authors.forename: Wilhelm Alexander
authors.initials: WA
authors.lastname: Osthaus
authors.forename: Timon
authors.initials: T
authors.lastname: Schröder
authors.forename: Natascha
authors.initials: N
authors.lastname: Teich
authors.forename: Carmen
authors.initials: C
authors.lastname: Dingemann
authors.forename: Joachim
authors.initials: J
authors.lastname: Kübler
authors.forename: Dietmar
authors.initials: D
authors.lastname: Böthig
authors.forename: Robert
authors.initials: R
authors.lastname: Sümpelmann
mesh_terms: D000818:Animals; D001810:Blood Volume / Q000502:physiology; D002245:Carbon Dioxide / Q000008:administration & dosage; D002302:Cardiac Output; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D007327:Insufflation; D011031:Pneumothorax, Artificial / Q000379:methods*; D012121:Respiration, Artificial / Q000379:methods*; D015656:Respiratory Mechanics / Q000502:physiology*; D013552:Swine
chemical_list: D002245:Carbon Dioxide