Galmén Karolina, Jakobsson Jan G, Freedman Jacob, Harbut Piotr
Department of Anaesthesia and Intensive Care, Institution for Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, 182 88, Sweden.
Department of Surgery, Institution for Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, 182 88, Sweden.
F1000Res. 2019 Apr 5;8:386. doi: 10.12688/f1000research.18369.1. eCollection 2019.
Stereotactic ablation of tumours in solid organs is a promising curative procedure in clinical oncology. The technique demands minimal target organ movements to optimise tumour destruction and prevent injury to surrounding tissues. High frequency jet ventilation (HFJV) is a novel option during these procedures, reducing the respiratory-associated movements of the liver. The effects of HFJV via endotracheal catheter on gas exchange during liver tumour ablation is not well studied. The aim of this explorative study was to assess lung function and the effects on blood gas and lactate during HFJV in patients undergoing stereotactic liver ablation. Blood gases were analysed in 25 patients scheduled for stereotactic liver ablation under general anaesthesia pre-induction, every 15 minutes during HFJV and following extubation in the recovery room. The HFJV was set at fixed settings. None of the patients developed hypoxia or signs of increased lactate production but a great variation in PaO /FiO ratio was found; from 13.1 to 71.3. An increase in mean PaCO was observed, from a baseline of 5.0 to a peak of 7.1 at 30 minutes (p <0.001) and a decrease was found in median pH, from a baseline of 7.44 to 7.31 at 15 minutes (p=0.03). We could not see any clear association between a decrease in PaO /FiO ratio and PaCO elevation. HFJV during general anaesthesia in patients undergoing stereotactic liver ablation is feasible and it did not cause hypoxemia or signs of increased lactate production. A reversible mild to moderate impairment of gas exchange was found during HFJV.
实体器官肿瘤的立体定向消融术是临床肿瘤学中一种很有前景的治疗方法。该技术要求靶器官的运动最小化，以优化肿瘤破坏并防止对周围组织造成损伤。高频喷射通气（HFJV）是这些手术过程中的一种新选择，可减少肝脏与呼吸相关的运动。经气管导管进行的HFJV对肝肿瘤消融期间气体交换的影响尚未得到充分研究。本探索性研究的目的是评估接受立体定向肝消融术患者在HFJV期间的肺功能以及对血气和乳酸的影响。对25例计划在全身麻醉诱导前接受立体定向肝消融术的患者进行血气分析，在HFJV期间每15分钟进行一次，在恢复室拔管后也进行分析。HFJV设置为固定参数。所有患者均未出现低氧血症或乳酸生成增加的迹象，但发现PaO₂/FiO₂比值存在很大差异，范围为13.1至71.3。观察到平均PaCO₂升高，从基线的5.0升至30分钟时的峰值7.1（p<0.001），并且发现中位pH值下降，从基线的7.44降至15分钟时的7.31（p=0.03）。我们未发现PaO₂/FiO₂比值降低与PaCO₂升高之间存在任何明确关联。接受立体定向肝消融术的患者在全身麻醉期间进行HFJV是可行的，且未导致低氧血症或乳酸生成增加的迹象。在HFJV期间发现了可逆的轻度至中度气体交换受损。
