single lung ventilation
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2021 ◽  
pp. 1-3
Author(s):  
Xin Zheng ◽  
Yang Su ◽  
Haitao Yang ◽  
Xin Zheng

Objective: To retrospectively analyse the lung ultrasound images of 60 patients undergoing thoracoscopic partial pneumonectomy and compare the difference of bilateral lung ultrasound images. Results: B3 lines were predominant in ventilating side lung, B7 lines and atelectasis were predominant in operative side lung. Conclusion: Short-term lung injury after one-lung ventilation is mainly on the ventilation side, and the main manifestation is pulmonary edema.


2021 ◽  
Author(s):  
Peng Cao ◽  
Shan Hu ◽  
Qiaoqiao Xu ◽  
Kangle Kong ◽  
Peng Han ◽  
...  

Abstract Intubated general anesthesia and single-lung ventilation are considered mandatory for conventional thoracoscopic surgery. Non-intubated thoracoscopic thymectomy is technically challenging. The aim of this article was to present the initial results of non-intubated subxiphoid-subcostal thoracoscopic thymectomy (NI-STT) under LMA management for patients with thymic tumor or myasthenia gravis (MG) and to investigate the feasibility and safety of the procedure. A retrospective analysis of patients undergoing NI-STT for thymic tumor or MG at our department from January 2017 to January 2020 was performed. The clinical characteristics and perioperative outcomes of the patients were reviewed and analyzed. A total of 61 patients were received NI-STT in this analysis, of which 19 patients with MG undergone an extended thymectomy and the rest (n=42) undergone a partial thymectomy. The anesthetic induction duration, surgical duration and global operating room duration were 24.83±12.27 min, 118.75±32.49 min and 173.51±41.80 min, respectively. The lowest SpO2 and peak EtCO2 during operation were 96.15±2.93 mmHg and 41.79±7.53 mmHg, respectively. The mean duration of chest drainage and postoperative hospital stays were 1.87 days, and 2.91 days, respectively. Three cases had sore throat and irritable cough and two cases suffered nausea and vomiting occurred. one patient suffered from an atrial fibrillation, two patients experienced pneumonia, and one patient suffered wound infection, respectively. There were no phrenic nerve paralysis and mortality occurred in the study group. The postoperative pain was low on 1,3, 7, 14, 30, 90 and 180 postoperative days. NI-STT was a technically safe and feasible approach for treating thymic tumors or MG. It could be an alternative to intubated single-lung ventilation for thymectomy in selected patients.


2021 ◽  
Vol 180 (2) ◽  
pp. 50-56
Author(s):  
O. V. Pikin ◽  
A. B. Ryabov ◽  
O. A. Alexandrov ◽  
N. I. Shcherbakova ◽  
N. A. Khrushcheva

A new approach for thymectomy in case of mediastinal shifting is proposed. Parasternal access provides optimal conditions for performing an adequate thymectomy, does not require single lung ventilation and could be used after previously performed pneumonectomy.


2021 ◽  
Author(s):  
Harry Ramcharran ◽  
Jason Wallen

Abstract BackgroundMediastinal teratomas are rare tumors that most frequently occur in the anterior mediastinum. The majority of these tumors are benign and slow growing. Due to their low malignant potential, the treatment for these tumors is surgical resection. The surgical management has shifted from invasive approaches such as a sternotomy to minimally invasive ones such as robotic-assisted thoracoscopic resections. Though many cases of mediastinal teratomas have been reported, we present a rare case of a locally advanced mediastinal teratoma requiring patient repositioning and change in ventilatory management mid-procedure to facilitate complete resection.Case PresentationA 43 year-old female was found to have an anterior mediastinal mass during work-up for an intermittent cough in 2009. Chest imaging and biopsy at the time showed evidence of a cystic teratoma without concerning features. She underwent imaging surveillance until 2018, when chest imaging showed increasing growth and worrisome radiologic features concerning for malignant degeneration. She underwent an elective robotic-assisted thoracoscopic resection utilizing double lung ventilation, but due to extensive involvement of the right lung, pericardium, superior vena cava, and right phrenic nerve the patient had to be repositioned and started on single lung ventilation mid-procedure to facilitate a safe and complete resection.ConclusionsAnterior mediastinal teratomas can be successfully removed by robotic-assisted thoracoscopic resections utilizing single lung ventilation. Though robotic-assisted thoracoscopic resection utilizing double lung ventilation can be effective in performing lung wedge resections and pleural biopsies, it is limited in removing locally advanced mediastinal tumors.


Author(s):  
GEYIK Fatih Dogu ◽  
Yuce Yucel ◽  
Arslan Gulten ◽  
Saracoglu Kemal Tolga

2021 ◽  
Author(s):  
Di Lu ◽  
Zhizhi Wang ◽  
Ziming Chen ◽  
Jiayang fan ◽  
Jianxue Zhai ◽  
...  

Abstract Background: Single-lung ventilation (SLV) associated acute lung injury is similar to ischemia reperfusion (IR) injury which is usually occurred during lung surgery. Olmesartan (Olm), a novel angiotensin receptor blocker (ARB), has been reported to ameliorate organ IR injury. Several recent studies have shown that lung microbiota may be involved in pulmonary diseases, but the effect of pulmonary microbiota in SLV-induced lung injury has not been reported. This study aims to determine the mechanism of how Olm attenuates SLV induced lung injury. Results: 24 Sprague Dawley (SD) rats were randomly divided into four groups: S (sham) group; AS (ARB + sham) group, in which the rats were given 7 days Olm treatment before the sham surgery; I (injury) group, in which the rats underwent SLV for 1 h (right lung ventilation and left lung collapsed) and double lungs ventilation for 3 h; and the AI (ARB + injury) group. Our data showed that 7 days Olm treatment before modeling markedly alleviated SLV-induced lung injury by suppressing inflammation and reactive oxygen species. Bronchoalveolar lavage fluid samples from the injured side were collected for 16S rRNA gene-based sequencing analysis. A total of 53 different bacteria at the genus and species levels were identified, among which Burkholderiaceae was more enriched in group I compared with group S, but significantly decreased in AI group after Olm treatment. Fecal samples were then collected for gut microbiota analysis using 16S rRNA gene-based sequencing analysis, which revealed no significant difference between the A and AS group. Furthermore, the injured lung samples were collected for metabolomics analysis using liquid chromatography-mass spectrometry analyses to explore differential metabolites among all groups. The Kyoto Encyclopedia of Genes and Genomes (KEGG) was applied to analyze the correlation between differential metabolites and lung microbiota. A total of 38 pathways were identified according to differential metabolites and 275 relevant pathways were enriched via analyzing the microbial community, 24 pathways were both identified by analyzing either metabolites or microbiota, including pyrimidine metabolism, purine metabolism, aminoacyl-tRNA biosynthesis and ATP-binding cassette transporter. Conclusions: Besides classical blockage of the renin-angiotensin II system, Olm could also alleviate SLV-induced lung injury by rewiring the interaction between pulmonary microbiota and metabolites.


PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254399
Author(s):  
Maximilian Edlinger-Stanger ◽  
Martin-Hermann Bernardi ◽  
Katharina Kovacs ◽  
Michael Mascha ◽  
Thomas Neugebauer ◽  
...  

Background Respiratory heat exchange is an important physiological process occurring in the upper and lower respiratory tract and is usually completed when inspired gases reach the alveoli. Animal and human studies demonstrated that heat exchange can be modulated by altering pulmonary ventilation and perfusion. The purpose of this study was to examine the effect of acute ventilation-perfusion (V/Q) mismatch on respiratory heat exchange. In clinical practice, monitoring respiratory heat exchange might offer the possibility of real-time tracking of acute V/Q-mismatch. Methods In 11 anesthetized, mechanically ventilated pigs, V/Q-mismatch was established by means of four interventions: single lung ventilation, high cardiac output, occlusion of the left pulmonary artery and repeated whole-lung lavage. V/Q-distributions were determined by the multiple inert gas elimination technique (MIGET). Respiratory heat exchange was measured as respiratory enthalpy using the novel, pre-commercial VQm™ monitor (development stage, Rostrum Medical Innovations, Vancouver, CA). According to MIGET, shunt perfusion of low V/Q compartments increased during single lung ventilation, high cardiac output and whole-lung lavage, whereas dead space and ventilation of high V/Q compartments increased during occlusion of the left pulmonary artery and whole-lung lavage. Results Bohr dead space increased after pulmonary artery occlusion and whole-lung lavage, venous admixture increased during single lung ventilation and whole-lung lavage, PaO2/FiO2 was decreased during all interventions. MIGET confirmed acute V/Q-mismatch. Respiratory enthalpy did not change significantly despite significant acute V/Q-mismatch. Conclusion Clinically relevant V/Q-mismatch does not impair respiratory heat exchange in the absence of additional thermal stressors and may not have clinical utility in the detection of acute changes.


Author(s):  
Husam H. Balkhy ◽  
Sarah Nisivaco ◽  
Avery Tung ◽  
Gianluca Torregrossa ◽  
Sachin Mehta

Objective Robotic off-pump totally endoscopic coronary artery bypass (TECAB) usually requires isolated single (right) lung ventilation to adequately expose the surgical site. However, in some patients, persistent oxygen desaturation may occur and conversion to cardiopulmonary bypass (CPB) or sternotomy may be necessary. We reviewed the characteristics and clinical outcomes in patients who did not tolerate single-lung ventilation during TECAB surgery. Methods After Institutional Review Board approval we reviewed 440 patients undergoing robotic TECAB at our institution between July 2013 and April 2019. Patients were separated into 2 groups based on their ability to tolerate single-lung ventilation during the procedure. Group 1 included patients able to tolerate single-lung ventilation and Group 2 were patients who required double-lung ventilation to tolerate the procedure. Early and mid-term outcomes were compared. Results Group 2 (121 patients) had higher Society of Thoracic Surgeons scores, higher body mass index, and more triple-vessel disease than Group 1 (319 patients). Group 2 had more bilateral internal mammary artery use, multivessel grafting, and longer operative times. One patient underwent conversion to sternotomy and 5 required CPB (all in Group 1). Intensive care unit and hospital length of stay were longer in Group 2. Observed/expected mortality did not differ between groups (1.06% in Group 2 vs 0.4% in Group 1; P = 0.215). At mid-term follow-up, cardiac-related/overall mortality and freedom from major adverse cardiac events were similar. Conclusions In our cohort, intolerance of single-lung ventilation did not preclude robotic off-pump TECAB. Double-lung ventilation is feasible during the procedure and may prevent conversions to sternotomy or use of CPB, resulting in excellent early and mid-term outcomes.


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