The role of an ambient pressure oxygen source during one-lung ventilation for thoracoscopic surgery
| Autor: | J. Pfitzner |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
medicine.medical_specialty
030204 cardiovascular system & hematology Critical Care and Intensive Care Medicine law.invention 03 medical and health sciences 0302 clinical medicine 030202 anesthesiology law Thoracoscopy medicine Humans Apnoeic oxygenation Collapse (medical) Lung medicine.diagnostic_test Thoracic Surgery Video-Assisted business.industry respiratory system One lung ventilation One-Lung Ventilation respiratory tract diseases Surgery Oxygen Anesthesiology and Pain Medicine medicine.anatomical_structure Anesthesia Ventilation (architecture) medicine.symptom Airway business Ambient pressure |
| Zdroj: | Anaesthesia and Intensive Care. 44:20-27 |
| ISSN: | 1448-0271 0310-057X |
| DOI: | 10.1177/0310057x1604400105 |
| Popis: | Video-assisted thoracoscopic surgery is facilitated by prompt collapse of the non-ventilated (‘operated’) lung, and interrupted and impeded if there is a need for oxygen (O2) delivery by continuous positive airways pressure in order to manage hypoxaemia. It has been proposed that connecting an ambient pressure O2 source to the airway of the non-ventilated lung at the time one-lung ventilation is initiated and before the chest is opened will, by avoiding entrainment of ambient nitrogen, serve to facilitate lung collapse. It has also been proposed that leaving the O2 source connected will enable, not only ongoing apnoeic oxygenation before the chest is opened, but also the thoracoscopic procedure to commence with the operated lung fully pre-oxygenated (with an inspired oxygen fraction of 1), and apnoeic oxygenation to continue throughout the operative procedure in those patients who exhibit a degree of small airways patency at ambient pressure. In reality, several factors can influence the speed of collapse of the operated lung, and very many factors can influence the incidence of hypoxaemia during one-lung ventilation. It therefore appears unlikely that the necessary evidence to support these proposals will be forthcoming from randomised clinical studies on large numbers of patients. Rather, the necessary evidence may only be provided by specifically designed within-patient clinical measurement studies. Nevertheless, it is argued that, in the meantime, there is already sufficient rationale for an ambient pressure O2 source to be connected to the airway of the non-ventilated lung, and for it to remain connected for the duration of one-lung ventilation. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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