Continuous Procedural Full-Lung Ventilation During Minimally Invasive Coronary Bypass Grafting Stephan Sixt, MD, Hug Aubin, MD, Robert Kalb, MD, Philipp.

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Presentation transcript:

Continuous Procedural Full-Lung Ventilation During Minimally Invasive Coronary Bypass Grafting Stephan Sixt, MD, Hug Aubin, MD, Robert Kalb, MD, Philipp Rellecke, MD, Artur Lichtenberg, MD, Alexander Albert, MD The Annals of Thoracic Surgery Volume 104, Issue 6, Pages 1994-2000 (December 2017) DOI: 10.1016/j.athoracsur.2017.05.017 Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Fan technique. Pledgeted pericardial sutures are placed along the pericardium starting cranially just below the entrance of the left internal mammary artery into the thorax cavity and moving downward along the right outflow tract to the apex and the right cardiophrenic angle. Those so-called fan sutures are then externalized outside the thorax over a minimal incision through the fifth and sixth intercostal space lateral to the skin incision and kept under strain, forming a fanlike pattern inside the pleural cavity. (A) Single-lung ventilation showing fanlike pattern of placed pericardial sutures. (B) Procedural full-lung ventilation with fan sutures retaining the left lung lobes from entering the surgical site. Asterisks (*) indicate fan sutures. The Annals of Thoracic Surgery 2017 104, 1994-2000DOI: (10.1016/j.athoracsur.2017.05.017) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Ventilation pressure. Patients were ventilated with 100% oxygen concentration, in volume control mode, and ventilation was adjusted by blood gas analysis. During single-lung ventilation, ventilation pressure was significantly higher than baseline ventilation after anesthesia induction. There were no significant differences between baseline and procedural full-lung ventilation (p = 0.123). Ventilation pressure was significantly higher (p < 0.0001) during single-lung ventilation than during procedural full-lung ventilation. The Annals of Thoracic Surgery 2017 104, 1994-2000DOI: (10.1016/j.athoracsur.2017.05.017) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Respiratory frequency. Patients were ventilated with 100% oxygen concentration, in volume control mode, and ventilation was adjusted by blood gas analysis. During single-lung ventilation, the respiratory rate was significantly higher (p < 0.0001; 14.4 ± 2.2 versus 12.3 ± 1.3 breaths per minute) than baseline ventilation after anesthesia induction and during procedural full-lung ventilation (p = 0.0004; 14.4 ± 2.2 versus 13.1 ± 1.4 breaths per minute). In addition, during procedural full-lung ventilation, the respiratory rate was significantly higher than baseline (p = 0.0062; 13.1 ± 1.4 versus 12.3 ± 1.3 breaths per minute). The Annals of Thoracic Surgery 2017 104, 1994-2000DOI: (10.1016/j.athoracsur.2017.05.017) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Minute volume. Patients were ventilated with 100% oxygen concentration, in volume control mode, and ventilation was adjusted by blood gas analysis. During single-lung ventilation, the minute volume was significantly lower (p = 0.0003; 6.2 ± 1 mm Hg versus 6.7 ± 0.9 mm Hg) with regard to baseline ventilation after anesthesia induction and during procedural full-lung ventilation (p < 0.0001; 6.2 ± 1 L/min versus 7.4 ± 1.1 L/min). In addition, during procedural full-lung ventilation, the minute volume was significantly higher than baseline (p = 0.0002; 7.4 ± 1.1 L/min versus 6.7 ± 0.9 L/min). The Annals of Thoracic Surgery 2017 104, 1994-2000DOI: (10.1016/j.athoracsur.2017.05.017) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Arterial oxygen partial pressure. Patients were ventilated with 100% oxygen concentration, in volume control mode, and ventilation was adjusted by blood gas analysis. During single-lung ventilation, the oxygen concentration was significantly lower (p < 0.0001; 376.2 ± 93 mm Hg versus 153.2 ± 71) than baseline ventilation after anesthesia induction and during procedural full-lung ventilation (p < 0.0001; 376.2 ± 93 mm Hg versus 294.9 ± 74.6 mm Hg). In addition, during procedural full-lung ventilation, the oxygen concentration was significantly lower than baseline (p = 0.0026; 294.9 ± 74.6 mm Hg versus 376.2 ± 93 mm Hg). The Annals of Thoracic Surgery 2017 104, 1994-2000DOI: (10.1016/j.athoracsur.2017.05.017) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions