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Image-based monitoring of one-lung ventilation

Published online by Cambridge University Press:  01 December 2008

S. Jean*
Affiliation:
University of Medicine and Dentistry of New Jersey, Robert Wood Johnson School of Medicine, Cooper University Hospital, Division of Critical Care Medicine, Department of Medicine, Camden, NJ, USA
I. Cinel
Affiliation:
University of Medicine and Dentistry of New Jersey, Robert Wood Johnson School of Medicine, Cooper University Hospital, Division of Critical Care Medicine, Department of Medicine, Camden, NJ, USA
I. Gratz
Affiliation:
University of Medicine and Dentistry of New Jersey, Robert Wood Johnson School of Medicine, Cooper University Hospital, Department of Anesthesiology, Camden, NJ, USA
C. Tay
Affiliation:
University of Medicine and Dentistry of New Jersey, Robert Wood Johnson School of Medicine, Cooper University Hospital, Division of Critical Care Medicine, Department of Medicine, Camden, NJ, USA
V. Lotano
Affiliation:
University of Medicine and Dentistry of New Jersey, Robert Wood Johnson School of Medicine, Cooper University Hospital, Department of Cardiovascular Surgery, Camden, NJ, USA
E. Deal
Affiliation:
University of Medicine and Dentistry of New Jersey, Robert Wood Johnson School of Medicine, Cooper University Hospital, Department of Anesthesiology, Camden, NJ, USA
J. E. Parrillo
Affiliation:
University of Medicine and Dentistry of New Jersey, Robert Wood Johnson School of Medicine, Cooper University Hospital, Division of Critical Care Medicine, Department of Medicine, Camden, NJ, USA
R. P. Dellinger
Affiliation:
University of Medicine and Dentistry of New Jersey, Robert Wood Johnson School of Medicine, Cooper University Hospital, Division of Critical Care Medicine, Department of Medicine, Camden, NJ, USA
*
Correspondence to: Smith Jean, Department of Medicine, Division of Critical Care Medicine, Cooper University Hospital, Robert Wood Johnson School of Medicine, University of Medicine and Dentistry of New Jersey, One Cooper Plaza, Dorrance Building, Suite 393, Camden, NJ 08103, USA. E-mail: [email protected]; Tel: +856-342-2926; Fax: +856-968-8306
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Summary

Background and objectives

With the increasing demand for one-lung ventilation in both thoracic surgery and other procedures, identifying the correct placement becomes increasingly important. Currently, endobronchial intubation is suspected based on a combination of auscultation and physiological findings. We investigated the ability of the visual display of airflow-induced vibrations to detect single-lung ventilation with a double-lumen endotracheal tube.

Methods

Double-lumen tubes were placed prior to surgery. Tracheal and endobronchial lumens were alternately clamped to produce unilateral lung ventilation of right and left lung. Vibration response imaging, which detects vibrations transmitted to the surface of the thorax, was performed during both right- and left-lung ventilation. Geographical area of vibration response image as well as amount and distribution of lung sounds were assessed.

Results

During single-lung ventilation, the image and video obtained from the vibration response imaging identifies the ventilated lung with a larger and darker image on the ventilated side. During single-lung ventilation, 87.2 ± 5.7% of the measured vibrations was detected over the ventilated lung and 12.8 ± 5.7% over the non-ventilated lung (P < 0.0001). It was also noted that during single-lung ventilation, the vibration distribution in the non-ventilated lung had a majority of vibration detected by the medial sensors closest to the midline (P < 0.05) as opposed to the midclavicular sensors when the lung is ventilated.

Conclusions

During single-lung ventilation, vibration response imaging clearly showed increased vibration in the lung that is being ventilated. Distribution of residual vibration differed in the non-ventilated lung in a manner that suggests transmission of vibrations across the mediastinum from the ventilated lung. The lung image and video obtained from vibration response imaging may provide useful and immediate information to help one-lung ventilation assessment.

Type
Original Article
Copyright
copyright © European Society of Anaesthesiology 2008

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References

1.Cohen, E. Double-lumen tube position should be confirmed by fiberoptic bronchoscopy. Curr Opin Anaesthesiol 2004; 17: 16.CrossRefGoogle ScholarPubMed
2.Campos, JH, Hallam, EA, Van Natta, T, Kernstine, KH. Devices for lung isolation used by anesthesiologists with limited thoracic experience. Anesthesiology 2006; 104: 261266.CrossRefGoogle ScholarPubMed
3.O’Connor, CJ, Mansy, H, Balk, RA et al. Identification of endotracheal tube malpositions using computerized analysis of breath sounds via electronic stethoscopes. Anesth Analg 2005; 101: 735739.CrossRefGoogle ScholarPubMed
4.Tejman-Yarden, S, Lederman, D, Eilig, I et al. Acoustic monitoring of double-lumen ventilated lungs for the detection of selective unilateral lung ventilation. Anesth Analg 2006; 103: 14891493.CrossRefGoogle ScholarPubMed
5.Dellinger, RP, Jean, S, Cinel, I et al. Regional distribution of acoustic-based lung vibration as a function of mechanical ventilation mode. Crit Care 2007; 11 (1): R26.CrossRefGoogle ScholarPubMed
6.Dellinger, RP, Parrillo, JE, Kushnir, A et al. Dynamic Visualization of Lung Sounds with a Vibration Response Device: A Case Series. Respiration 2008; 75: 6072.CrossRefGoogle ScholarPubMed
7.Cinel, I, Jean, S, Tay, C et al. Vibration response imaging findings following inadvertent esophageal intubation. Can J Anaesth 2008; 55 (3): 172176.CrossRefGoogle ScholarPubMed
8. Rasband WS. Image J: US National Institutes of Health, Bethesda, Maryland, USA. http://rsb.info.nih.gov/ij/, 1997–2007.Google Scholar
9.Klein, U, Karzai, W, Bloos, F et al. Role of fiberoptic bronchoscopy in conjunction with the use of double-lumen tubes for thoracic anesthesia: a prospective study. Anesthesiology 1998; 88: 346350.CrossRefGoogle ScholarPubMed
10.Inoue, S, Nishimine, N, Kitaguchi, K et al. Double lumen tube location predicts tube malposition and hypoxaemia during one lung ventilation. Br J Anaesth 2004; 92: 195201.CrossRefGoogle ScholarPubMed
11.Tejman-Yarden, S, Zlotnik, A, Weizman, L et al. Acoustic monitoring of lung sounds for the detection of one-lung intubation. Anesth Analg 2007; 105: 397404.Google ScholarPubMed
12.Alliaume, B, Coddens, J, Deloof, T. Reliability of auscultation in positioning of double-lumen endobronchial tubes. Can J Anaesth 1992; 39: 687690.CrossRefGoogle ScholarPubMed