Prophylactic Use of Continuous Positive Airway Pressure to Operative Lung During One-Lung Ventilation Can Minimize Bleomycin Pulmonary Toxicity: A Report of Two Cases

Nicholas Cavanaugh; Sudhakar Subramani; Tyler J Foster; Satoshi Hanada

doi:10.7759/cureus.36150

Prophylactic Use of Continuous Positive Airway Pressure to Operative Lung During One-Lung Ventilation Can Minimize Bleomycin Pulmonary Toxicity: A Report of Two Cases

Cureus. 2023 Mar 14;15(3):e36150. doi: 10.7759/cureus.36150. eCollection 2023 Mar.

Authors

Nicholas Cavanaugh¹, Sudhakar Subramani¹, Tyler J Foster², Satoshi Hanada¹

Affiliations

¹ Department of Anesthesia, University of Iowa Hospitals and Clinics, Iowa City, USA.
² Department of Anesthesia, MercyOne Des Moines Medical Center, Des Moines, USA.

Abstract

Bleomycin, a common antineoplastic agent, is known to cause bleomycin pulmonary toxicity when the lungs are exposed to a high fraction of inspired oxygen (FiO₂) level. Thus, intraoperative one-lung ventilation (OLV) is challenging in a patient with bleomycin treatment because maintaining high FiO₂ during OLV is a common practice in thoracic surgery to ensure adequate oxygenation while providing adequate lung isolation. We report two thoracic surgical cases where prophylactic continuous positive airway pressure (CPAP) was applied on the non-dependent lung during OLV while limiting FiO₂ to prevent postoperative respiratory complications.

Keywords: bleomycin; one-lung ventilation; pulmonary toxicity; thoracic anesthesia; thoracic surgery; video-assisted thoracoscopic surgery.

Publication types

Case Reports