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Case Reports
. 2019 Nov 9:49:28-32.
doi: 10.1016/j.amsu.2019.10.032. eCollection 2020 Jan.

Intraoperative oxygen challenge for toleration of single lung ventilation in a patient with severe obstructive airway disease: A case report

Laurence Weinberg  1 , Luka Cosic  1 , Maleck Louis  1 , Tom Garry  1 , Patryck Lloyd-Donald  1 , Stephen Barnett  2 , Lachlan F Miles  1
Affiliations
Case Reports

Intraoperative oxygen challenge for toleration of single lung ventilation in a patient with severe obstructive airway disease: A case report

Laurence Weinberg et al. Ann Med Surg (Lond). .

Abstract

Perioperative risk assessment is complex in patients with chronic obstructive pulmonary disease who have undergone previous lung resection surgery. A 70-year-old female with severe chronic obstructive pulmonary disease and previous right middle and lower lobectomy, presented for left lower lobe superior segmentectomy. Respiratory function tests revealed a forced expiratory volume in 1 second of 0.72L, a forced vital capacity of 1.93L, and a carbon monoxide transfer factor of 10.0 ml/min/mmHg. A cardiopulmonary exercise test demonstrated little ventilatory reserve with profound arterial desaturation on peak exercise, however, a normal peak oxygen consumption (16.7 ml/min/kg) and a nadir minute ventilation/carbon dioxide slope of 24 implied a limited risk of perioperative cardiovascular morbidity. Given these conflicting results we performed an intraoperative oxygen challenge test under general anaesthesia with sequential ventilation of different lobes of the lung. We demonstrate the use of the oxygen challenge test as an effective intervention to further assess safety and tolerance of anaesthesia of patients with limited respiratory reserve being assessed for further complex redo lung resection surgery. Further, this test was a risk stratification tool that allowed informed decisions to be made by the patient about therapeutic options for treating their lung cancer. The prognostic value of traditional physiological parameters in patients with chronic obstructive pulmonary disease who have undergone previous lung resection surgery is uncertain. The intraoperative oxygen challenge test is another risk stratification tool to assist clinicians in assessment of safety and tolerance of anaesthesia for patients being considered for lung resection.

Keywords: Anaesthesia; Bronchial blocker; COPD, chronic obstructive pulmonary disease; CPET, cardiopulmonary exercise testing; CT, computed tomography; Case report; FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; Risk stratification; SABR, stereotactic ablative radiotherapy; SPECT, single photon emission computed tomography; TLCO, carbon monoxide transfer factor; Thoracic surgery; VE/VCO2, minute ventilation/carbon dioxide; VO2, maximum oxygen consumption.

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Conflict of interest statement

The authors declare they have no conflicts of interests.

Figures

Fig. 1
Fig. 1
Cardiopulmonary exercise test showing relationship between oxygen saturation, heart rate and oxygen consumption (V02) during exercise.
Fig. 2
Fig. 2
Intraoperative oxygen challenge test with positioning of the bronchial blocker and corresponding arterial blood gas measurements.
See this image and copyright information in PMC

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