Summary and Conclusions
Blood gases and acid-base status of fourteen patients undergoing thoracic surgery were studied. All patients were intubated with the Carlens catheter. A large degree of pulmonary shunting and corresponding hypoxaemia was often seen during collapse of one lung. Attempts to prevent the mediastinal shift and to reverse atelectasis in the dependent lung with increased expiratory pressure further decreased arterial oxygen tension in most patients. The mechanism involved in this adverse effect is most likely an increase of shunting through the collapsed non-dependent lung. However, effects of decreased cardiac output on these parameters cannot be excluded from the present study.
Increased expiratory pressure appears to reverse collapse of air spaces, but its effect on Pao2 was not seen until after release of the pressure. This type of ventilation does not seem to be effective in correcting the hypoxaemia that may accompany the use of the Carlens catheter during thoracic surgery.
Résumé
On a étudié les gaz sanguins et ľéquilibre acide-base de 14 malades soumis à la chirurgie thoracique. Tous les malades ont été intubés par le tube Carlens. On a souvent observé durant le collapsus ďun poumon un degré important de “shunt” pulmonaire et ďhypoxémie correspondante. Des tentatives pour préVenir le déplacement médiastinal et pour renverser ľatélectasie dans le poumon contrô1é a ľaide ďune pression expiratoire augmentée a diminué davantage le tension ďoxygène art6riel chez la plupart des malades. Le mécanisme impliqué dans cet effet contraire est probablement une augmentation du “shunt” à travers le poumon collabé. Cependant, ďaprès cette étude, les effets ďun débit cardiaque diminué sur ces paramètres ne peuvent pas être exclus.
Une pression expiratoire augmentée semble renverser le collapsus des alvéoles, mais son effet sur la Pao2 n’a été observe qu’après cessation de la pression. Ce genre de ventilation ne semble pas efficace pour corriger ľhypoxémié qui peut accompagner ľemploi du tube Carlens durant la chirurgie thoracique.
Article PDF
Similar content being viewed by others
References
Lunding, M. &Fernandes, A. Arterial Oxygen Tension and Acid-Base Status during Thoracic Anesthesia: With Special Reference to the Effort of Total Collapse of One Lung as Obtained by Using Double-Lumen Tubes. Acta anaesth. Scandinav.11: 43 (1967).
Tarhan, S. &Lundborg, R. O. Blood Gas and pH Studies during Use of the Carlens Catheter. Canad. Anaesth. Soc. J.15: 458 (1968).
Tappin, A.R. The Control of Positive Intrapulmonary Pressure during Thoracotomy. Anaesthesia.24: 108 (1969).
Frumin, M. J.;Bergman, N. A.;Holaday, D. A.;Rackow, H.; &Salanitre, E. Alveolar-arterial O2 Differences during Artificial Respiration in Man. J. Appl. Physiol.14: 694 (1959).
Singer, R. B. &Hastings, A. B. An Improved Clinical Method for the Estimation of Disturbances of Acid-Base Balance of Human Blood. Medicine.27: 223 (1948).
Laver, M. B. &Seifen, A. Measurement of Blood Oxygen Tension in Anesthesia. Anesthesiology,26: 73 (1965).
Raine, June M. &Bishop, J. M. A-a Difference in O2 Tension and Physiological Dead Space in Normal Man. J. Appl. Physiol.18: 284 (1963).
Michenfelder, J. D.;Fowler, W. S.; &Theye, R. A. CO2 Levels and Pulmonary Shunting in Anesthetized Man. J. Appl. Physiol.21: 1471 (1966).
Virtue, R. W.;Permutt, S.;Tanaka, R.;Pearcy, C;Bane, H. N.; &Bromberger-Barnea, B. Ventilation-Perfusion Changes During Thoracotomy. Anesthesiology.27: 132 (1966).
Craig, J. O. C.;Bromley, L. L.; &Williams, R. Thoracotomy and Contralateral Lung: A Study of the Changes Occurring in the Dependent and Contralateral Lung during and after Thoracotomy in Lateral Decubitus. Thorax.17: 9 (1962).
Andersen, M. N. &Kuchiba, K. Depression of Cardiac Output With Mechanical Ventilation: Comparative Studies of Intermittent Positive, Positive-Negative, and Assisted Ventilation. J. Thorac. Cardiov. Surg.54: 182 (1967).
Cheney, F. W.;Hornbein, T. F.; &Crawford, E. W. The Effect of Expiratory Resistance on the Blood Gas Tensions of Anesthetized Patients. Anesthesiology.28: 670 (1967).
Clowes, G. H. A. Jr.,;Alichniewicz, A.; DelGuercio, L. R. M.; &Gillespie, D. The Relationship of Postoperative Acidosis to Pulmonary and Cardiovascular Function. J. Thorac. Cardiov. Surg.39: 1 (1960).
Hill, T. R.;Finley, T. N.;Takamura, J. H.;Orallo, M.; &Bonica, J. J. The Effect of Inflation Pressure in the Contralateral Lung on Blood Flow through an Atelectatic Lung in the Dog. (Abstr.) Fed. Proc.21: 108 (1962).
Tarhan, S.;Moffitt, E. A.; &Sessler, A. D. The Effect of Dead-Space Rebreathing on Postoperative Atelectasis. Anesth. & Analg.48: 721 (1969).
Additional information
Mayo Clinic and Mayo Foundation, Section of Anesthesiology, Rochester, Minnesota.
Rights and permissions
About this article
Cite this article
Tarhan, S., Lundborg, R.O. Effects of increased expiratory pressure on blood gas tensions and pulmonary shunting during thoracotomy with use of the carlens catheter. Canad. Anaesth. Soc. J. 17, 4–11 (1970). https://doi.org/10.1007/BF03004523
Issue Date:
DOI: https://doi.org/10.1007/BF03004523