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Canadian Journal of Anesthesia

, Volume 50, Issue 4, pp 411–414 | Cite as

Alarming hypoxemia during one-lung ventilation in a patient with respiratory bronchiolitis-associated interstitial lung disease

  • Anis S. Baraka
  • Samar K. Taha
  • Chadi I. Yaacoub
Cardiothoracic Anesthesia, Respiration and Airway
Accepted:

Abstract

Purpose

To report a patient with respiratory bronchiolitis-associated interstitial lung disease (RB-ILD) who developed severe hypoxemia during one-lung ventilation (OLV).

Clinical features

A 27-yr-old female, ex-smoker presented with productive cough and dyspnea of 18-month duration. The chestx-ray revealed diffuse abnormalities involving both lungs consisting of interstitial emphysema with irregular shadowing. Preoperative PaO2 was 88 mmHg and pulmonary function tests showed moderate obstructive disease. The patient underwent right open lung biopsy. After induction of anesthesia, a left double lumen tube was inserted and its position verified with auscultation and fibreoptic bronchoscopy. Upon initiation of OLV, the patient developed severe hypoxemia and the PaO2 dropped from 500 mmHg during twolung ventilation (TLV) to SO mmHg. Hypoxemia was readily corrected by resuming TLV

Conclusion

The severe hypoxemia during OLV in this patient with RB-ILD may be attributed to impaired hypoxic pulmonary vasoconstriction. Other causes were not excluded. Caution is warranted when initiating OLV in these patients.

Keywords

Chronic Obstructive Pulmonary Disease Idiopathic Pulmonary Fibrosis Interstitial Lung Disease Hypoxic Pulmonary Vasoconstriction Open Lung Biopsy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Hypoxémie inquiétante pendant la ventilation unilatérale chez une patiente souffrant de pneumopathie interstitielle respiratoire associée à une bronchiolite

Résumé

Objectif

Présenter une patiente atteinte de pneumopathie interstitielle respiratoire associée à une bronchiolite (PIR-B), compliquée d’une hypoxémie sévère pendant la ventilation unilatérale (VUL).

Éléments cliniques

Une femme de 27 ans, ancienne fumeuse, a consuité pour une toux productive et une dyspnée qui duraient depuis 18 mois. La radiographie pulmonaire a révélé des anomalies diffuses aux deux poumons, formées par l’emphysème interstitiel caractérisé par des opacités irrégulières. La PaO2 préopératoire était de 88 mmHg et les épreuves fonctionnelles respiratoires ont montré une affection obstructive modérée. La patiente a subi une biopsie ouverte du poumon droit. Après l’induction de l’anesthésie, une sonde à double lumière gauche a été insérée et sa position vérifiée par auscultation et fibroscopie bronchique. Dès le début de la VUL, une sévère hypoxémie est apparue et la PaO2 a chuté de 500 mmHg à 50 mmHg pendant la ventilation bilatérale (VBL). L’hypoxémie a été rapidement corrigée par la reprise de la VBL.

Conclusion

L’hypoxémie sévère qui s’est produite pendant la VUL chez une patiente atteinte de PIR-B peut être attribuée, entre autres causes, à l’altération vasoconstrictive pulmonaire hypoxique. La prudence est de mise quand on procède à la VUL dans de telles circonstances.

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Copyright information

© Canadian Anesthesiologists 2003

Authors and Affiliations

  • Anis S. Baraka
    • 1
  • Samar K. Taha
    • 1
  • Chadi I. Yaacoub
    • 1
  1. 1.Department of AnesthesiologyAmerican University of Beirut-Medical CenterBeirut

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