Two-Lung Ventilation Useful During Pneumothorax Repair

A new study has found that when managing a pneumothorax with a needle-sized thoracoscope, two-lung ventilation anesthesia with low tidal volume is better than a one-lung approach with higher tidal volume.

Researchers at Korea University Guro Hospital (Seoul) reported on 108 patients with spontaneous pneumothorax who underwent bleb resection with a 2-mm thoracoscope. In alternating order, the authors assigned patients to either a one-lung or a two-lung protocol. The patients in the one-lung group were intubated with a single-lumen endotracheal tube, and ventilated with a tidal volume of 4 mL/kg and a respiratory rate of 23 cycles per minute, at a fractional inspired oxygen concentration (FiO2) of 50%. In the two-lung group, the authors used double-lumen endotracheal tubes for separate lung ventilation. Patients were ventilated with a tidal volume of 8 mL/kg and a respiratory rate of 12 cycles per minute, at an equal FiO2 of 50%.

The researchers found that airway pressure was significantly lower in the two-lung group (8 versus 24 mmHg). The time from intubation to incision was also significantly shorter (17.1 versus 35.3 minutes). Operative times were similar in both groups, but anesthesia time was significantly longer in the one-lung group (77.9 versus 64.9 minutes). The study was published online on August 6, 2010, in the European Respiratory Journal.

"Needlescopic bleb resection using the two-lung approach was safe, technically feasible, cost effective, and time saving compared to one-lung ventilation anesthesia,” concluded lead author Hyun Koo Kim, M.D., and colleagues at the anesthesiology, pain medicine, and thoracic and cardiovascular surgery departments. "It could provide an alternative option for a relatively short and simple procedure such as bleb resection for spontaneous pneumothorax.”

One-lung ventilation facilitates visualization during thoracic surgical procedures, particularly video-assisted thoracoscopic surgery (VATS); however, it may also cause hypoxemia and tracheobronchial injury. In addition, due to the need to confirm the proper position of the tube by fiberoptic bronchoscopy, more time and costs may be involved.

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Korea University Guro Hospital