TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN THE MANAGEMENT OF WHOLE LUNG LAVAGE

The effects of two lung ventilation, one lung ventilation and alveolar lavage on right ventricular mechanics in a patient have been observed using transoesophageal echocardiography (TOE). Alveolar lavage result ed in additional stresses to those of one lung ventilation (OLV) and t he point when these were noted to be resulting in right ventricular ch anges was used as the signal to terminate the filling phase of a cycle of alveolar lavage. A significant increase in right ventricle afterlo ad occurred on starting OLV. The response to lung ravage was biphasic, initially a further increase in afterload followed by a reduction in preload. Because there was rapid adaptation to these changes, it was f elt appropriate to perform sequential lung lavage during the same anae sthetic. In similar circumstances where pulmonary vascular resistance is changed, information obtained from TOE may be used to guide therapy .