A comparative study of two- versus one-lung ventilation for needlescopic bleb resection

This prospective study was conducted to evaluate the feasibility of two-lung (TL) ventilation with low tidal volume anaesthesia compared with one-lung (OL) ventilation for needlescopic bleb resection. Patients with spontaneous pneumothorax that underwent bleb resection with a 2-mm thoracoscope were enrolled. During the operation, the tidal volume was set at 4.0 mL.kg(-1) in the TL group and 8.0 mL.kg(-1) in the OL group; the respiration rate was set at 23 and 12 breaths.min(-1), respectively, at the same inspiratory oxygen fraction (50%). A total of 108 patients (55 patients in the TL group and 53 in the OL group) were included in this study. Airway pressure was significantly lower in the TL group (mean +/- SD 8.0 +/- 3.3 versus 24.0 +/- 3.9 mmHg in the OL group; p<0.001). The time from endotracheal intubation to the incision was 17.1 +/- 4.0 min in the TL group and 35.3 +/- 7.6 min in the OL group, which was significantly different (p<0.001). However, the operation time was not different in comparisons between the two groups. Therefore, the total anaesthesia time was significantly longer in the OL group (77.9 +/- 21.6 versus 64.9 +/- 14.7 min in the TL group; p=0.002). Needlescopic bleb resection using TL ventilation anaesthesia with low tidal volume was technically feasible, cost-effective and time-saving compared with OL ventilation anaesthesia.