Unilateral high frequency jet ventilation supporting one-lung ventilation during thoracic surgical procedures

We report two cases where surgery on the right lung had to be performed for resection of a malignoma. In both cases,function of the left lung was seve rely restricted. In the first patient, the volume on this side was reduced by around 50% as the result of a recently performed upper lobe resection. I n the second patient, perfusion of the left lung accounted for only 18% of the total lung perfusion. On the basis of these changes we considered conve ntional one-lung ventilation impracticable and performed surgery using diff erential lung ventilation. The dependent (left) lung was ventilated by inte rmittent positive pressure ventilation (IPPV), where the tidal volume in th e first patient had to be reduced to 200 ml because of high airway pressure s. Ventilation of the non-dependent (right) side was performed simultaneous ly in both patients by means of high frequency jet ventilation (HFJV). Unde r this procedure arterial O-2 saturation ranged from 96 to 100%, and arteri al CO2 partial pressure was 45 mmHg. Surgery was not hindered by ventilatio n, the postoperative progress was also without complications. The case repo rts show that with the help of the ventilation regime described (operated s ide: HFJV, non-operated side: IPPV) lung surgery can be successfully perfor med on patients who are unsuitable for conventional one-lung ventilation fo r functional reasons.