Techniques and complications of one-lung ventilation in children with suppurative lung disease:: Experience in 15 cases

Objective: To evaluate lung isolation with Fogarty catheters and to analyze respiratory consequences of one-lung ventilation (OLV) in children with suppurative lung disease. Design: Prospective. Setting: University hospital. Participants: Fifteen children undergoing thoracotomy. Interventions: Bronchial blockade with a 7F Fogarty catheter was attempted. In case of incomplete blockade or failure in directing the catheter into the desired mainstem bronchus, endobronchial intubation was done. Volume-controlled ventilation was performed with fraction of inspired oxygen (FIO2), 0.5; inspiratory-to-expiratory (I: E) ratio, 1:2; and 10 mL/kg tidal volume during two-lung ventilation (TLV). FIO2 was increased to 1.0 by the initiation of OLV. If peak airway pressure exceeded basal values during TLV by 35%, tidal volume was reduced to 8 mL/kg, inspiratory pause was zeroed, and I:E ratio was increased to 1:1. Hemodynamic and respiratory parameters were recorded during TLV and 30 minutes after initiation of OLV. Peripheral oxygen saturation and end-tidal carbon dioxide tension were recorded every 5 minutes. Measurements and Main Results: Right lung isolation was successfully obtained by Fogarty catheters in 10 children undergoing right thoracotomy. Endobronchial intubation was performed in 2 children (40%) undergoing left thoracotomy. Three children (20%) developed episodes of severe hypercapnia and hypoxia requiring treatment during OLV. All of the parameters recorded at 30 minutes of OLV revealed statistically significant differences from TLV. OLV was transiently discontinued in 1 child. Conclusion: The use of Fogarty embolectomy catheters for lung isolation in children undergoing thoracotomy is recommended. Respiratory problems are not rare during OLV in children with suppurative lung disease and require immediate management. Copyright (C) 2001 by W.B. Saunders Company.