One-lung flooding reduces the ipsilateral diaphragm motion during mechanical ventilationReport as inadecuate




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European Journal of Medical Research

, 21:9

First Online: 08 March 2016Received: 09 January 2016Accepted: 26 February 2016DOI: 10.1186-s40001-016-0205-1

Cite this article as: Lesser, T.G., Schubert, H., Güllmar, D. et al. Eur J Med Res 2016 21: 9. doi:10.1186-s40001-016-0205-1

Abstract

BackgroundDiaphragm motion during spontaneous or mechanical respiration hinders image-guided percutaneous interventions of tumours in lung and upper abdomen. Motion-tracking methods can be applied but increase procedure complexity and procedure time. One-lung flooding OLF generates a suitable acoustic pathway to lung tumours and likely suppress diaphragm motion. The aim of this study was to quantify the effect of OLF on ipsilateral diaphragm motion during contralateral one-lung ventilation.

MethodsTo measure the diaphragm motion, M-mode ultrasonography of the right hemidiaphragm was performed during spontaneous breathing and mechanical ventilation, as well as after right-side lung flooding, in three pigs. Diaphragm motion was analysed using magnetic resonance images during left-side lung flooding and mechanical ventilation, in four pigs.

ResultsDouble-lung ventilation increased the diaphragm movement in comparison with spontaneous breathing 17.8 ± 4.4 vs. 12.2 ± 3.4 mm, p = 0.014. Diaphragm movement on the flooded side during contralateral one-lung ventilation was significantly reduced compared to that during double-lung ventilation 3.9 ± 1.0 vs. 17.8 ± 4.4 mm, p = 0.041. By analysing the magnetic resonance images, the hemidiaphragm on the flooded side showed an average displacement of 4.2 mm, a maximum displacement of 15 mm close to the ventilated lung and no displacement at the lateral side.

ConclusionOLF leads to a drastic reduction of diaphragm motion on the ipsilateral side which implies that targeting and motion compensation algorithms for interventions like high-intensity focused ultrasound ablation of intrapulmonary and hepatic lesions might not be required.

KeywordsLiver or lung tumours HIFU Lung flooding Diaphragm motion Magnetic resonance imaging AbbreviationsHIFUhigh-intensity focused ultrasound

MRgHIFUmagnetic resonance-guided HIFU

HFJVhigh-frequency jet ventilation

HFOVhigh-frequency oscillatory ventilation

OLFone-lung flooding

PEEPpositive end-expiratory pressure

FIO2fraction of inspired oxygen

ECGelectrocardiography

TVtidal volume

SDstandard deviation

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Author: Thomas Günther Lesser - Harald Schubert - Daniel Güllmar - Jürgen R. Reichenbach - Frank Wolfram

Source: https://link.springer.com/







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