One lung ventilation at high altitude (11600 ft) for video assisted thoracoscopic surgery (VATS) in a case of covid-19 sequela-empyema thoracis

Abstract

Lung isolation for surgical facilitation by means of one lung ventilation (OLV) is seeing widespread use in all age groups due to increasing incidence of thoracoscopy and video-assisted thoracoscopic surgery (VATS). Lung isolation is most commonly achieved by use of double-lumen endotracheal tubes with or without a bronchial blocker. Development of intraoperative hypoxaemia (arterial oxygen saturation <90%) caused by OLV is a known hazard. In high altitude area (HAA), the lowered amount of O2 caused by a decrease in the barometric pressure (BP) leads to hypobaric hypoxia. Covid 19 directly impacts the lungs and damages the alveoli in the affected individuals exacerbating the hypoxia. Though rare, respiratory long-term sequelae of COVID-19 such as lung abscess can occur. The management of hypoxia in the course of lung isolation was a challenge especially in the high-altitude scenario with a Covid-19 background. The present report is of an adult male with high COVID-19 antibody titres who underwent video-assisted thoracoscopic surgery at a service hospital located in a high-altitude area (HAA) with altitude 11600 ft. One lung ventilation was performed with a 39 Fr left double lumen tube. Correct placement was confirmed with fiber optic bronchoscopy. The surgery was uneventful and the patient was electively ventilated postoperatively for 48 hrs. No complications were noted peri-operatively. The soldier was subsequently discharged for convalescence.