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Techniques and complications of one-lung ventilation in children with suppurative lung disease: experience in 15
E Camci1, M Tuğrul, S T Tuğrul
1Department of Anesthesiology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey.
Insights
Fogarty catheters effectively isolate lungs in pediatric thoracotomy, but one-lung ventilation (OLV) can cause respiratory issues in children with lung disease. Careful monitoring and management are essential during OLV.
Area of Science:
- Pediatric Anesthesiology
- Thoracic Surgery
- Respiratory Physiology
Background:
- Lung isolation is crucial for thoracic surgery.
- Suppurative lung disease presents unique challenges for ventilation.
- Fogarty catheters offer a potential method for lung isolation.
Purpose of the Study:
- To assess the efficacy of Fogarty catheters for lung isolation in children undergoing thoracotomy.
- To analyze the respiratory consequences of one-lung ventilation (OLV) in this population.
Main Methods:
- Prospective study at a university hospital involving 15 children undergoing thoracotomy.
- Attempted bronchial blockade with 7F Fogarty catheters; endobronchial intubation used if needed.
- Monitored hemodynamic and respiratory parameters during two-lung ventilation (TLV) and OLV.
Main Results:
- Successful lung isolation with Fogarty catheters in 10/15 children (right thoracotomy).
- Endobronchial intubation required in 2/5 children (left thoracotomy).
- Significant respiratory changes observed during OLV, with 3 children experiencing hypercapnia/hypoxia.
Conclusions:
- Fogarty embolectomy catheters are recommended for lung isolation in pediatric thoracotomy.
- Respiratory complications during OLV in children with suppurative lung disease are common and require prompt intervention.
Objective:
To evaluate lung isolation with Fogarty catheters and to analyze respiratory consequences of one-lung ventilation (OLV) in children with suppurative lung disease.
Design:
Prospective.
Setting:
University hospital.
Participants:
Fifteen children undergoing thoracotomy.
Interventions:
Bronchial blockade with a 7F Fogarty catheter was attempted. In case of incomplete blockade or failure in directing the catheter into the desired mainstem bronchus, endobronchial intubation was done. Volume-controlled ventilation was performed with fraction of inspired oxygen (F(I)O2), 0.5; inspiratory-to-expiratory (I: E) ratio, 1:2; and 10 mL/kg tidal volume during two-lung ventilation (TLV). F(I)O2 was increased to 1.0 by the initiation of OLV. If peak airway pressure exceeded basal values during TLV by 35%, tidal volume was reduced to 8 mL/kg, inspiratory pause was zeroed, and I:E ratio was increased to 1:1. Hemodynamic and respiratory parameters were recorded during TLV and 30 minutes after initiation of OLV. Peripheral oxygen saturation and end-tidal carbon dioxide tension were recorded every 5 minutes.
Measurements And Main Results:
Right lung isolation was successfully obtained by Fogarty catheters in 10 children undergoing right thoracotomy. Endobronchial intubation was performed in 2 children (40%) undergoing left thoracotomy. Three children (20%) developed episodes of severe hypercapnia and hypoxia requiring treatment during OLV. All of the parameters recorded at 30 minutes of OLV revealed statistically significant differences from TLV. OLV was transiently discontinued in 1 child.
Conclusion:
The use of Fogarty embolectomy catheters for lung isolation in children undergoing thoracotomy is recommended. Respiratory problems are not rare during OLV in children with suppurative lung disease and require immediate management.