High-frequency, small-volume ventilation during thoracic surgery.

Surgical conditions during conventional mechanical ventilation (CMV) and pulmonary gas exchange were compared with those during high-frequency ventilation (HFV) in 24 patients undergoing anesthesia for intrathoracic surgery. HFV at an oscillatory frequency of 3 Hz and a delivered gas volume of 1.3-1.9 ml/kg provided excellent surgical conditions for peripheral lung procedures. However, surgical conditions for procedures on the major airways or mediastinal structures were unsatisfactory during HFV. Adequate pulmonary gas exchange was achieved with HFV when the chest was open. Further evidence is presented for expiratory flow limitation during HFV. Expiratory flow limitation seems to occur particularly in patients with chronic obstructive airway disease, leading to increased lung volume. Currently, the authors do not recommend HFV for routine use during anesthesia for thoracic surgery.