Lesser T, Wolfram F, Braun C, Gottschall R. Effects of unilateral superimposed high-frequency jet ventilation on porcine hemodynamics and gas exchange during one-lung flooding. World J Exp Med 2024; 14(1): 87256 [PMID: 38590298 DOI: 10.5493/wjem.v14.i1.87256]
Corresponding Author of This Article
Thomas Lesser, MD, Adjunct Professor, Department of Thoracic and Vascular Surgery, SRH Wald Klinikum Gera, No. 122 Street of Peace, Gera D-07548, Germany. thomas.lesser@srh.de
Research Domain of This Article
Medicine, Research & Experimental
Article-Type of This Article
Basic Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Exp Med. Mar 20, 2024; 14(1): 87256 Published online Mar 20, 2024. doi: 10.5493/wjem.v14.i1.87256
Effects of unilateral superimposed high-frequency jet ventilation on porcine hemodynamics and gas exchange during one-lung flooding
Thomas Lesser, Frank Wolfram, Conny Braun, Reiner Gottschall
Thomas Lesser, Frank Wolfram, Department of Thoracic and Vascular Surgery, SRH Wald Klinikum Gera, Gera D-07548, Germany
Conny Braun, Central Experimental Animal Facility, Jena University Hospital, Jena 07743, Germany
Reiner Gottschall, Department of Anaesthesiology and Intensive Care, Jena University Hospital, Jena 07747, Germany
Author contributions: Lesser T designed, coordinated the study, performed the experiments and wrote the manuscript; Wolfram F collected and analysed data; Braun C performed the anesthesia, monitored vital functions and was responsible for animal care; Gottschall R performed the ventilation of animals, reviewed the manuscript; all authors approved the final version of the article.
Institutional animal care and use committee statement: All procedures involving animals were reviewed and approved by the Institutional Animal Care and Use Committee of the Thuringian State Authority.
Conflict-of-interest statement: All other authors have nothing to disclose.
Data sharing statement: No additional data are available.
ARRIVE guidelines statement: The authors have read the ARRIVE guidelines, and the manuscript was prepared and revised according to the ARRIVE guidelines.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Thomas Lesser, MD, Adjunct Professor, Department of Thoracic and Vascular Surgery, SRH Wald Klinikum Gera, No. 122 Street of Peace, Gera D-07548, Germany. thomas.lesser@srh.de
Received: September 13, 2023 Peer-review started: September 13, 2023 First decision: November 21, 2023 Revised: November 30, 2023 Accepted: December 29, 2023 Article in press: December 29, 2023 Published online: March 20, 2024 Processing time: 187 Days and 22.2 Hours
Abstract
BACKGROUND
Superimposed high-frequency jet ventilation (SHFJV) is suitable for respiratory motion reduction and essential for effective lung tumor ablation. Fluid filling of the target lung wing one-lung flooding (OLF) is necessary for therapeutic ultrasound applications. However, whether unilateral SHFJV allows adequate hemodynamics and gas exchange is unclear.
AIM
To compared SHFJV with pressure-controlled ventilation (PCV) during OLF by assessing hemodynamics and gas exchange in different animal positions.
METHODS
SHFJV or PCV was used alternatingly to ventilate the non-flooded lungs of the 12 anesthetized pigs during OLF. The animal positions were changed from left lateral position to supine position (SP) to right lateral position (RLP) every 30 min. In each position, ventilation was maintained for 15 min in both modalities. Hemodynamic variables and arterial blood gas levels were repeatedly measured.
RESULTS
Unilateral SHFJV led to lower carbon dioxide removal than PCV without abnormally elevated carbon dioxide levels. SHFJV slightly decreased oxygenation in SP and RLP compared with PCV; the lowest values of PaO2 and PaO2/FiO2 ratio were found in SP [13.0; interquartile range (IQR): 12.6-5.6 and 32.5 (IQR: 31.5-38.9) kPa]. Conversely, during SHFJV, the shunt fraction was higher in all animal positions (highest in the RLP: 0.30).
CONCLUSION
In porcine model, unilateral SHFJV may provide adequate ventilation in different animal positions during OLF. Lower oxygenation and CO2 removal rates compared to PCV did not lead to hypoxia or hypercapnia. SHFJV can be safely used for lung tumor ablation to minimize ventilation-induced lung motion.
Core Tip: Lung cancer prognosis is among the most unfavourable of all cancers. Therefore, there is a need to improve local lung cancer therapy while avoiding surgery. One-lung flooding (OLF) involves unilateral lung filling with saline, which generates a suitable acoustic pathway for the transthoracic application of High-intensity focused ultrasound (HIFU) in the lung. Breathing and lung movement during HIFU procedures can result in incomplete tumor ablation or collateral damage. Superimposed high-frequency jet ventilation (SHFJV) can reduce respiratory motion. However, it is unclear whether unilateral SHFJV allows adequate haemodynamics and gas exchange. In this porcine model, unilateral SHFJV may provide adequate ventilation to animals in different positions during OLF. Lower oxygenation and carbon dioxide removal rates compared to pressure controlled ventilation did not lead to hypoxia or hypercapnia. SHFJV can safely minimise ventilation-induced lung motion during lung tumor ablation.
