Quantitative assessment of atelectasis formation under high frequency jet ventilation during liver tumour ablation-A computer tomography study

• Published in: PloS one 2023-04, Vol.18 (4), p.e0282724
• Main Authors: Galmén, Karolina, Jakobsson, Jan G, Perchiazzi, Gaetano, Freedman, Jacob, Harbut, Piotr
• Format: Article
• Language: English
• Subjects: Ablation; Ablation (Surgery); Anesthesia; Atelectasis; Atmospheric pressure; Biology and Life Sciences; Carbon dioxide; Care and treatment; Catheters; Clinical medicine; Complications and side effects; Computed tomography; General anesthesia; High frequencies; High-Frequency Jet Ventilation - adverse effects; High-Frequency Jet Ventilation - methods; Humans; Intubation; Liver; Liver cancer; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - surgery; Lung cancer; Lungs; Mechanical ventilation; Medical instruments; Medicin och hälsovetenskap; Medicine and Health Sciences; Observational studies; Patient outcomes; Patients; Pulmonary Atelectasis - diagnostic imaging; Pulmonary Atelectasis - etiology; Radiation; Research and Analysis Methods; Respiration; Supine position; Surgery; Tomography; Tomography, X-Ray Computed; Tumors; Ventilation; Ventilators
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0282724

High frequency jet ventilation (HFJV) can be used to minimise sub-diaphragmal organ displacements. Treated patients are in a supine position, under general anaesthesia and fully muscle relaxed. These are factors that are known to contribute to the formation of atelectasis. The HFJV-catheter is inserted freely inside the endotracheal tube and the system is therefore open to atmospheric pressure. The aim of this study was to assess the formation of atelectasis over time during HFJV in patients undergoing liver tumour ablation under general anaesthesia. In this observational study twenty-five patients were studied. Repeated computed tomography (CT) scans were taken at the start of HFJV and every 15 minutes thereafter up until 45 minutes. From the CT images, four lung compartments were defined: hyperinflated, normoinflated, poorly inflated and atelectatic areas. The extension of each lung compartment was expressed as a percentage of the total lung area. Atelectasis at 30 minutes, 7.9% (SD 3.5, p = 0.002) and at 45 minutes 8,1% (SD 5.2, p = 0.024), was significantly higher compared to baseline 5.6% (SD 2.5). The amount of normoinflated lung volumes were unchanged over the period studied. Only a few minor perioperative respiratory adverse events were noted. Atelectasis during HFJV in stereotactic liver tumour ablation increased over the first 45 minutes but tended to stabilise with no impact on normoinflated lung volume. Using HFJV during stereotactic liver ablation is safe regarding formation of atelectasis.