High-frequency percussive ventilation improves perioperatively clinical evolution in pulmonary resection.

Area of Science:

• Thoracic Surgery
• Respiratory Physiology
• Anesthesiology

Background:

• One-lung ventilation during thoracotomy often uses positive end-expiratory pressure (PEEP) or continuous positive airway pressure (CPAP) to prevent hypoxemia.
• These conventional methods can impede the removal of pulmonary secretions.
• High-frequency percussive ventilation (HFPV) is explored as an alternative to address these limitations.

Purpose of the Study:

• To investigate the efficacy of HFPV in improving oxygenation and secretion clearance during one-lung ventilation.
• To evaluate the impact of HFPV on postoperative outcomes, including hospital length of stay.
• To compare HFPV with CPAP in patients undergoing pulmonary resection.

Main Methods:

• A randomized prospective study was conducted at a university hospital.
• Fifty-three patients undergoing elective pulmonary partial resection were enrolled, with nine excluded.
• Patients were ventilated with HFPV (n=22) or CPAP (n=22) for the non-dependent lung, while the dependent lung received continuous mechanical ventilation.

Main Results:

• HFPV demonstrated significantly higher partial arterial oxygen pressure (PaO2) before non-dependent lung re-expansion compared to CPAP (p = 0.020).
• Patients with chronic obstructive pulmonary disease (COPD) treated with HFPV produced substantially more secretions (199 mL vs. 64 mL, p = 0.028).
• HFPV use was associated with a 5.28-fold increased likelihood of sputum production in COPD patients (p < 0.0001) and a 3.14-fold greater chance of earlier hospital discharge (p = 0.0007).

Conclusions:

• HFPV effectively improves oxygenation during one-lung ventilation in pulmonary resection.
• Postoperatively, HFPV enhances secretion removal and reduces hospital length of stay compared to CPAP.
• HFPV presents a promising ventilatory strategy for thoracic surgery patients, particularly those with COPD.