dr. keerthi chigurupati

82 Pages·2016·3.26 MB·English

EFFECTIVENESS OF VENTILATION OF NON-DEPENDANT LUNG
FOR A BRIEF PERIOD IN IMPROVING THE ARTERIAL
OXYGENATION DURING ONE LUNG VENTILATION -
A PROSPECTIVE STUDY

Thesis submitted for the partial fulfilment for the requirement of the
Degree of DM (Cardiothoracic and vascular Anaesthesia)

BY
DR. KEERTHI CHIGURUPATI
DM CARDIOTHORACIC AND VASCULAR ANAESTHESIA RESIDENT
2014-2016
DEPARTMENT OF ANAESTHESIOLOGY
SREE CHITRA TIRUNAL INSTITUTE FOR MEDICAL
SCIENCES AND TECHNOLOGY, TRIVANDRUM, KERALA,
INDIA - 695011

i
DECLARATION

I hereby declare that this thesis entitled “Effectiveness of ventilation of non-
dependent lung for a brief period in improving arterial oxygenation during
one-lung ventilation- A prospective study” has been prepared by me under the
able guidance of Dr. Suneel P.R and Dr.Unnikrishnan. K.P, Division of
Cardiothoracic and Vascular Anaesthesia, Department of Anaesthesiology, at Sree
Chitra Tirunal Institute for Medical Sciences & Technology, Thiruvananthapuram.

Date:
Place:
DR. KEERTHI CHIGURUPATI
DM Cardiothoracic and Vascular
Anesthesiology Resident,
Department of Anaesthesiology,
SCTIMST, Thiruvananthapuram

ii
CERTIFICATE

This is to certify that this thesis entitled “Effectiveness of ventilation of
non-dependent lung for a brief period in improving arterial oxygenation
during one-lung ventilation- A prospective study” has been prepared by
Dr. Keerthi Chigurupati, DM Cardiothoracic and Vascular Anaesthesiology
Resident, Division of Cardiothoracic and Vascular Anaesthesiology at Sree Chitra
Tirunal Institute for Medical Sciences & Technology, Thiruvananthapuram. She
has shown keen interest in preparing this project.
(GUIDE)
Dr. Suneel P.R
Professor in Anesthesiology,
SCTIMST, Thiruvananthapuram

(CO GUIDE)
Dr. Unnikrishnan K.P
Professor in Anesthesiology,
SCTIMST, Thiruvananthapuram

iii
CERTIFICATE

This is to certify that this thesis entitled “Effectiveness of ventilation of
non-dependent lung for a brief period in improving arterial oxygenation
during one-lung ventilation- A prospective study” has been prepared by
Dr. Keerthi Chigurupati, DM Cardiothoracic and Vascular Anaesthesiology
Resident, Division of Cardiothoracic and Vascular Anaesthesiology at Sree Chitra
Tirunal Institute for Medical Sciences & Technology, Thiruvananthapuram. She
has shown keen interest in preparing this project.

Date:
Place:

Dr.Rupa Sreedhar,
Professor, head of the department
Division of Cardiothoracic and
vascular Anaesthesiology,
Department of Anaesthesiology,
SCTIMST, Thiruvananthapuram

iv
ACKNOWLEDGEMENT

v
vi
CONTENTS
TOPIC PAGE NUMBER
INTRODUCTION 1
AIMS AND OBJECTIVES 2
REVIEW OF LITERATURE 3
MATERIALS AND METHODS 18
RESULTS 23
DISCUSSION 33
CONCLUSION 39
BIBLIOGRAPHY 40
ABBREVIATIONS 44
ANNEXURES 45
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vii
INTRODUCTION
Introduction

INTRODUCTION

One lung ventilation (OLV) using double lumen tube (DLT) is a standard
procedure for lung resections. OLV carries a risk of hypoxemia irrespective of the
ventilatory strategy used, with reported incidence of hypoxemia around 5-10%1.
On occasions, hypoxia may turn life-threatening, requiring institution of
ventilatory measures that will require immediate, temporary cessation of surgery.
Hypoxemia during OLV is multifactorial but transpulmonary shunt caused by the
perfusion of the collapsed, non-ventilated lung is the predominant cause2.
Ventilatory manipulations of the non-dependent lung (NDL) have been employed
with a view to reduce the shunt in patients who become hypoxemic on one lung
ventilation. Continuous Positive Airway Pressure (CPAP) and intermittent
reinflation are the most frequently used ventilatory manipulations of the NDL,
both of which require inflation of the NDL3,4. Intermittent inflation/deflation of the
NDL with oxygen has been done manually during OLV with improvement in
saturation5. None of the techniques described produces consistent improvement in
oxygenation during OLV. We studied the impact of intermittent positive pressure
ventilation of the NDL with small tidal volume on improving oxygenation during
OLV without interfering with the surgical dissection during thoracotomy.
1
AIMS AND OBJECTIVES