Elective use of high frequency oscillatory ventilation with transcutaneous carbon dioxide monitoring during thoracoscopic diaphragmatic hernia repair

Michelle M LeRiger, Arlyne Thung, Karen Diefenbach, Edward Shepherd, Erin Wishloff, Joseph D. Tobias

Research output: Contribution to journalArticle

Abstract

Thoracoscopy, a minimally invasive technique, for congenital diaphragmatic hernia (CDH) repair has been shown to offer significant advantages versus open procedures. However, positive pressure ventilation during thoracoscopy can be challenging. Minimizing lung movement is important to improve surgical visualization, but one-lung ventilation can be difficult in neonates and infants. Ventilation-perfusion inequalities occur in the lateral decubitus position making it challenging to maintain oxygenation and control hypercarbia from carbon dioxide insufflation. High frequency oscillatory ventilation (HFOV) offers an alternative means of ventilation for such cases. It maintains a constant distending pressure for the alveoli and optimal lung volumes while limiting peak inflating pressures and thus lung over distention. This provides a means of ensuring adequate oxygenation and ventilation with minimal lung movement, allowing adequate intraoperative exposure. During HFOV, continuous monitoring of carbon dioxide (CO2) can be problematic as end-tidal technology is not feasible. As such, we used transcutaneous CO2 (PtcCO2) monitoring in our patient. We present the elective intraoperative institution of HFOV with PtcCO2 monitoring in a 4-day-old infant for thoracoscopic repair of CDH. Previous reports regarding the intraoperative use of HFOV are reviewed and its application in this scenario is discussed. The utility of continuous PtcCO2 monitoring during such cases is presented.

Original languageEnglish (US)
Pages (from-to)287-292
Number of pages6
JournalAnaesthesia, Pain and Intensive Care
Volume16
Issue number3
StatePublished - Sep 1 2012

Fingerprint

High-Frequency Ventilation
Diaphragmatic Hernia
Herniorrhaphy
Carbon Dioxide
Ventilation
Thoracoscopy
Lung
One-Lung Ventilation
Pressure
Insufflation
Positive-Pressure Respiration
Hypercapnia
Perfusion
Newborn Infant
Technology
Congenital Diaphragmatic Hernias

Keywords

  • Congenital diaphragmatic hernia
  • High frequency oscillatory ventilation (HFOV)
  • Hypercarbia
  • Oxygenation
  • Thoracoscopy
  • Transcutaneous CO (PtcCO) monitoring

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Anesthesiology and Pain Medicine

Cite this

Elective use of high frequency oscillatory ventilation with transcutaneous carbon dioxide monitoring during thoracoscopic diaphragmatic hernia repair. / LeRiger, Michelle M; Thung, Arlyne; Diefenbach, Karen; Shepherd, Edward; Wishloff, Erin; Tobias, Joseph D.

In: Anaesthesia, Pain and Intensive Care, Vol. 16, No. 3, 01.09.2012, p. 287-292.

Research output: Contribution to journalArticle

LeRiger, Michelle M ; Thung, Arlyne ; Diefenbach, Karen ; Shepherd, Edward ; Wishloff, Erin ; Tobias, Joseph D. / Elective use of high frequency oscillatory ventilation with transcutaneous carbon dioxide monitoring during thoracoscopic diaphragmatic hernia repair. In: Anaesthesia, Pain and Intensive Care. 2012 ; Vol. 16, No. 3. pp. 287-292.
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