High-frequency ventilation with an uncuffed endobronchial tube: A new technique for one-lung anesthesia

Abstract

Conventional one-lung intermittent positive-pressure ventilation (OL-IPPV) has been a valuable technique during anesthesia for intrathoracic operations. OL-IPPV has been associated with a high incidence of hypoxemia, as a result of the associated intrapulmonary shunt of 21% to 65% of cardiac output. The administration of OL-IPPV requires the use of a large cuffed endobronchial double-lumen tube. These tubes can be difficult to position properly and have been associated with malfunction, trauma, and tracheobronchial rupture. In an effort to avoid the problems associated with conventional OL-IPPV, we have developed a new technique of modified one-lung high-frequency ventilation (MOL-HFV). MOL-HFV is based on the administration of high-frequency ventilation (HFV) through a small uncuffed endobronchial tube. MOL-HFV was studied in 26 patients during a variety of intrathoracic surgical procedures, and it was compared to one-lung high-frequency ventilation (OL-HFV) and OL-IPPV in each patient. After the chest was opened, each patient received a sequence of OL-IPPV, OL-HFV, and MOL-HFV. Arterial PO2 was measured and intrapulmonary shunting was calculated after 30 minutes of each type of ventilation. This study showed that arterial PO2 was significantly higher during MOL-HFV (mean 379 mm Hg) than during OL-HFV (mean 235 mm HG) or OL-IPPV (mean 141 mm Hg). This was the result of a significantly lower intrapulmonary shunt during MOL-HFV (19%). We conclude that MOL-HFV through a small uncuffed endobronchial tube provides better oxygenation, optimal surgical access, and avoids the problems associated with the use of double-lumen tubes.