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

J Cardiothorac Vasc Anesth. 2010 Aug;24(4):602-7. doi: 10.1053/j.jvca.2009.10.029. Epub 2010 Jan 6.

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.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Coronary Artery Bypass* / methods
  • Female
  • Hemodynamics / physiology
  • High-Frequency Jet Ventilation / adverse effects
  • High-Frequency Jet Ventilation / instrumentation*
  • High-Frequency Jet Ventilation / methods*
  • Humans
  • Male
  • Middle Aged
  • Minimally Invasive Surgical Procedures* / adverse effects
  • Minimally Invasive Surgical Procedures* / instrumentation
  • Minimally Invasive Surgical Procedures* / methods
  • Prospective Studies
  • Respiration, Artificial / adverse effects
  • Respiration, Artificial / instrumentation
  • Respiration, Artificial / methods