Objectives: Video-assisted thoracoscopic surgery (VATS) has become a standard procedure in pediatric surgery. To facilitate surgical access, the dependent lung has to collapse using intrathoracic carbon dioxide insufflation and/or single-lung ventilation. These procedures can induce hemodynamic deteriorations in adults. The potential impacts of single-lung ventilation in combination with capnothorax on hemodynamics in infants have never been studied before.
Aim: We conducted a randomized experimental study focusing on hemodynamic and respiratory changes during single-lung ventilation with or without capnothorax in a pediatric animal model.
Methods: Twelve piglets were randomly assigned to receive single-lung ventilation with (SLV-CO(2) ) or without (SLV) capnothorax with an insufflation pressure of 5 mmHg for a period of two hours. Before, during, and after single-lung ventilation, hemodynamic and respiratory parameters were measured.
Results: Although mean arterial pressure remained stable during the course of the study and no critical incidents were monitored, cardiac index (CI) decreased significantly with SLV-CO(2) (baseline 3.6 ± 1.6 l · min(-1) · m(-2) vs 2.9 ± 1.1 l · min(-1) · m(-2) at 120 min, P < 0.05). Furthermore, global end-diastolic volume and intrathoracic blood volume (ITBV) decreased as well significantly with SLV-CO(2) , causing a significant between-group difference in ITBV (P < 0.05).
Conclusions: Despite a decrease in CI and preload parameters, the combination of single-lung ventilation and low-pressure capnothorax was well tolerated in piglets and could justify further clinical studies to be performed in infants and children focusing on hemodynamic and respiratory changes during VATS.
© 2011 Blackwell Publishing Ltd.