Basic Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Exp Med. Mar 20, 2024; 14(1): 87256
Published online Mar 20, 2024. doi: 10.5493/wjem.v14.i1.87256
Effects of unilateral superimposed high-frequency jet ventilation on porcine hemodynamics and gas exchange during one-lung flooding
Thomas Lesser, Frank Wolfram, Conny Braun, Reiner Gottschall
Thomas Lesser, Frank Wolfram, Department of Thoracic and Vascular Surgery, SRH Wald Klinikum Gera, Gera D-07548, Germany
Conny Braun, Central Experimental Animal Facility, Jena University Hospital, Jena 07743, Germany
Reiner Gottschall, Department of Anaesthesiology and Intensive Care, Jena University Hospital, Jena 07747, Germany
Author contributions: Lesser T designed, coordinated the study, performed the experiments and wrote the manuscript; Wolfram F collected and analysed data; Braun C performed the anesthesia, monitored vital functions and was responsible for animal care; Gottschall R performed the ventilation of animals, reviewed the manuscript; all authors approved the final version of the article.
Institutional animal care and use committee statement: All procedures involving animals were reviewed and approved by the Institutional Animal Care and Use Committee of the Thuringian State Authority.
Conflict-of-interest statement: All other authors have nothing to disclose.
Data sharing statement: No additional data are available.
ARRIVE guidelines statement: The authors have read the ARRIVE guidelines, and the manuscript was prepared and revised according to the ARRIVE guidelines.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Thomas Lesser, MD, Adjunct Professor, Department of Thoracic and Vascular Surgery, SRH Wald Klinikum Gera, No. 122 Street of Peace, Gera D-07548, Germany. thomas.lesser@srh.de
Received: September 13, 2023
Peer-review started: September 13, 2023
First decision: November 21, 2023
Revised: November 30, 2023
Accepted: December 29, 2023
Article in press: December 29, 2023
Published online: March 20, 2024
Processing time: 187 Days and 22.2 Hours
ARTICLE HIGHLIGHTS
Research background

Lung cancer prognosis is among the most unfavourable of all cancers. This is reflected in its relatively low 5-year survival rate. Therefore, there is a need to improve local tumour therapy while avoiding surgery. High-intensity focused ultrasound (HIFU) is the only highly effective non-invasive approach to ablating tumours in parenchymal organs outside the chest. A new method one-lung flooding (OLF) for complete lung sonography was developed that allows ultrasound-mediated lung tumour ablation. OLF involves unilateral lung filling with saline, which generates a suitable acoustic pathway for transthoracic application of HIFU in the lung. Saline filling of one lung requires one-lung ventilation of the contralateral lung.

Research motivation

Breathing and lung movement during HIFU procedures can result in incomplete tumour ablation or collateral damage. Superimposed high-frequency jet ventilation (SHFJV) can reduce respiratory motion. However, it is unclear whether unilateral SHFJV allows adequate haemodynamics and gas exchange.

Research objectives

This study aimed to compare SHFJV with pressure-controlled ventilation (PCV) during OLF by assessing hemodynamics and gas exchange relative to the animal position.

Research methods

SHFJV or PCV were used alternately to ventilate the non-flooded lungs of 12 anaesthetised pigs during OLF in different body positions. Haemodynamic variables and arterial blood gas levels were measured using both ventilation modalities.

Research results

Unilateral SHFJV yielded lower carbon dioxide removal than PCV; however, it did not result in elevated carbon dioxide levels. SHFJV exhibited slightly decreased oxygenation in pigs in supine position and RLP compared with PCV. The lowest arterial partial oxygen pressure and arterial partial oxygen pressure/ inspired oxygen fraction (Horowitz index) values were observed in SP [13.0; interquartile range (IQR): 12.6-5.6 and 32.5 (IQR: 31.5-38.9) kPa]. Conversely, SHFJV yielded the highest shunt fractions in all animal positions (highest in the RLP: 0.30).

Research conclusions

In this porcine model, unilateral SHFJV may provide adequate ventilation to animals in different positions during OLF. Lower oxygenation and carbon dioxide removal rates compared with PCV did not lead to hypoxia or hypercapnia.

Research perspectives

SHFJV can safely minimise ventilation-induced lung motion during lung tumour ablation.