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Joerg Ender¹, Magdalena Brodowsky, Volkmar Falk

¹Department of Anesthesiology and Intensive Care Medicine II, Heartcenter, University of Leipzig, Leipzig, Germany. joerg.ender@medizin.uni-leipzig.de

Journal of Cardiothoracic and Vascular Anesthesia

|January 9, 2010

Abstract

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.

Design:

Prospective, randomized, clinical study.

Setting:

University-affiliated heart center.

Participants:

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

Interventions:

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.

Measurements:

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.

Main 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.

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