Correspondence
position following traumatic thoracic spine injury. J Anesth 2008; 22: 170–2 3. Samantaray A. Tracheal intubation in the prone position with an intubating laryngeal mask airway following posterior spine impaled knife injury. Saudi J Anaesth 2011; 5: 329–31
| 1009
4. Subedi A, Tripathi M, Pathak L, Bhattarai B, Ghimire A, Koirala R. Curved knife “Khukuri” injury in the back and anaesthesia induction in lateral position for thoracotomy. J Nepal Med Assoc 2010; 50: 303–5
doi:10.1093/bja/aev126
Continuous positive airway pressure during one-lung ventilation and disturbed visibility L. Gallart*, A. Pérez-Ramos, J. Yélamos, V. Curull, and R. Aguiló
*E-mail: [email protected]
Editor—We read the interesting article by Verhage and colleagues1 on reduced local immune response with continuous positive airway pressure (CPAP) during one-lung ventilation (OLV). Our group is conducting a research protocol with similar objectives,2 and we have some comments and questions. The main problem of intraoperative CPAP is that the inflated lung can disturb the surgeon’s vision. In the article by Verhage and colleagues,1 CPAP disturbed visibility in nine of 15 patients (60%). In a pilot study before our trial in open thoracotomy for lung surgery,2 we realized that 5 cm H2O CPAP administered from the beginning of OLV was enough to maintain the lung excessively inflated. This is because the pressure needed to maintain an open lung is much lower than the pressure needed to inflate a collapsed lung.3 Thus, CPAP needed to avoid deflation is much lower than CPAP needed to inflate the collapsed lung as rescue for hypoxaemia. For this reason, in our research protocol we start with low CPAP (1–3 cm H2O) from the beginning of OLV, increasing the pressure during the surgery while looking at the inflation of the lung. Despite this individualized protocol, CPAP disturbed the vision of the surgeon in three of 12 patients recruited up to now. The CPAP had to be discontinued, and these three patients were lost for analysis. In summary, CPAP administered from the beginning of OLV needs to be low and should be titrated in agreement with the surgeon.
Furthermore, we have several questions in order to clarify the methods for further studies on this topic. Please let us know the external diameter of the bronchoscope used in this study, which determines the depth of the bronchial level achieved for the broncho-alveolar lavage. Also, we would like to know whether cytokine levels from the broncho-alveolar lavage fluid were normalized by alveolar protein content. Thank you for this opportunity to discuss this interesting topic.
Declaration of interest None declared.
References 1. Verhage RJ, Boone J, Rijkers GT, et al. Reduced local immune response with continuous positive airway pressure during onelung ventilation for oesophagectomy. Br J Anaesth 2014; 112: 920–8 2. Effects of Intraoperative Continuous Airway Pressure (CPAP) on the Inflammatory Response to One-lung Ventilation. NCT01368601 3. Lachmann B. Open lung in ARDS. Minerva Anestesiol 2002; 68: 637–42 doi:10.1093/bja/aev129
Reduced local immune response with continuous positive airway pressure during one-lung ventilation for oesophagectomy R. J. Verhage, A. C. Croese, and R. van Hillegersberg* Utrecht, The Netherlands *E-mail: [email protected]
Editor—We thank Gallart and colleagues for sharing their thoughts and recent experience with the application of Continuous Positive Airway Pressure (CPAP) during one lung ventilation (OLV) in open lung surgery.1 They present some methodological
questions, and their thoughts on the level of pressure used during CPAP. With respect to the methodology, we used a bronchoscope with a tip diameter of 3.4 mm (Pentax Fl 10- RBS) for endoscopically assisted retrieval of broncho alveolar lavage
Downloaded from http://bja.oxfordjournals.org/ at University of Texas at Austin on June 5, 2015
Barcelona, Spain
position following traumatic thoracic spine injury. J Anesth 2008; 22: 170–2 3. Samantaray A. Tracheal intubation in the prone position with an intubating laryngeal mask airway following posterior spine impaled knife injury. Saudi J Anaesth 2011; 5: 329–31
| 1009
4. Subedi A, Tripathi M, Pathak L, Bhattarai B, Ghimire A, Koirala R. Curved knife “Khukuri” injury in the back and anaesthesia induction in lateral position for thoracotomy. J Nepal Med Assoc 2010; 50: 303–5
doi:10.1093/bja/aev126
Continuous positive airway pressure during one-lung ventilation and disturbed visibility L. Gallart*, A. Pérez-Ramos, J. Yélamos, V. Curull, and R. Aguiló
*E-mail: [email protected]
Editor—We read the interesting article by Verhage and colleagues1 on reduced local immune response with continuous positive airway pressure (CPAP) during one-lung ventilation (OLV). Our group is conducting a research protocol with similar objectives,2 and we have some comments and questions. The main problem of intraoperative CPAP is that the inflated lung can disturb the surgeon’s vision. In the article by Verhage and colleagues,1 CPAP disturbed visibility in nine of 15 patients (60%). In a pilot study before our trial in open thoracotomy for lung surgery,2 we realized that 5 cm H2O CPAP administered from the beginning of OLV was enough to maintain the lung excessively inflated. This is because the pressure needed to maintain an open lung is much lower than the pressure needed to inflate a collapsed lung.3 Thus, CPAP needed to avoid deflation is much lower than CPAP needed to inflate the collapsed lung as rescue for hypoxaemia. For this reason, in our research protocol we start with low CPAP (1–3 cm H2O) from the beginning of OLV, increasing the pressure during the surgery while looking at the inflation of the lung. Despite this individualized protocol, CPAP disturbed the vision of the surgeon in three of 12 patients recruited up to now. The CPAP had to be discontinued, and these three patients were lost for analysis. In summary, CPAP administered from the beginning of OLV needs to be low and should be titrated in agreement with the surgeon.
Furthermore, we have several questions in order to clarify the methods for further studies on this topic. Please let us know the external diameter of the bronchoscope used in this study, which determines the depth of the bronchial level achieved for the broncho-alveolar lavage. Also, we would like to know whether cytokine levels from the broncho-alveolar lavage fluid were normalized by alveolar protein content. Thank you for this opportunity to discuss this interesting topic.
Declaration of interest None declared.
References 1. Verhage RJ, Boone J, Rijkers GT, et al. Reduced local immune response with continuous positive airway pressure during onelung ventilation for oesophagectomy. Br J Anaesth 2014; 112: 920–8 2. Effects of Intraoperative Continuous Airway Pressure (CPAP) on the Inflammatory Response to One-lung Ventilation. NCT01368601 3. Lachmann B. Open lung in ARDS. Minerva Anestesiol 2002; 68: 637–42 doi:10.1093/bja/aev129
Reduced local immune response with continuous positive airway pressure during one-lung ventilation for oesophagectomy R. J. Verhage, A. C. Croese, and R. van Hillegersberg* Utrecht, The Netherlands *E-mail: [email protected]
Editor—We thank Gallart and colleagues for sharing their thoughts and recent experience with the application of Continuous Positive Airway Pressure (CPAP) during one lung ventilation (OLV) in open lung surgery.1 They present some methodological
questions, and their thoughts on the level of pressure used during CPAP. With respect to the methodology, we used a bronchoscope with a tip diameter of 3.4 mm (Pentax Fl 10- RBS) for endoscopically assisted retrieval of broncho alveolar lavage
Downloaded from http://bja.oxfordjournals.org/ at University of Texas at Austin on June 5, 2015
Barcelona, Spain
