One-lung ventilation in infants and small children: blood gas values

Abstract

We investigated one-lung ventilation (OLV) in pediatric patients under 10 kg. The feasibility of OLV using either Arndt endobronchial blocker (AEB) or mainstem intubation technique is analyzed. Arterial blood gases (ABG) monitored throughout the procedures are presented. Following IRB approval, a retrospective chart review was conducted on 9 patients ≤6 months of age and 2 patients ≥12 months of age undergoing lung resections or aortic coarctations. For right thoracotomy, a conventional, cuffed, endotracheal tube (ETT) was inserted and guided into the left mainstem bronchus with a bronchoscope and the left lung was ventilated. For left thoracotomy, an AEB was inserted into the trachea 2 cm past the vocal cords and an ETT was placed through the cords adjacent to the blockers (extraluminal). A bronchoscope was then inserted through the ETT to visualize and manipulate the blocker into the left mainstem bronchus. The blocker cuff was inflated slowly under direct vision while the ETT continued to ventilate the right, dependent lung. ABG values were collected intraoperatively in all cases. One-lung ventilation could be accomplished within 15 min in all cases, and lung isolation was successful in all patients. All patients were extubated within 12 h of surgery and had an uneventful recovery. ABG values revealed modest arterial acidosis and hypercarbia and mild acute ventilatory insufficiency. The use of extraluminal AEB or mainstem intubation for OLV can be successfully completed in infants weighing less than 10 kg. OLV may induce acute respiratory pathology; therefore we recommend routine intraoperative ABG monitoring for pediatric patients.