Original Article

Image-based monitoring of one-lung ventilation

S. Jean^a1 c1, I. Cinel^a1, I. Gratz^a2, C. Tay^a1, V. Lotano^a3, E. Deal^a2, J. E. Parrillo^a1 and R. P. Dellinger^a1

^a1 University of Medicine and Dentistry of New Jersey, Robert Wood Johnson School of Medicine, Cooper University Hospital, Division of Critical Care Medicine, Department of Medicine, Camden, NJ, USA

^a2 University of Medicine and Dentistry of New Jersey, Robert Wood Johnson School of Medicine, Cooper University Hospital, Department of Anesthesiology, Camden, NJ, USA

^a3 University of Medicine and Dentistry of New Jersey, Robert Wood Johnson School of Medicine, Cooper University Hospital, Department of Cardiovascular Surgery, Camden, NJ, USA

Summary

Background and objectives With the increasing demand for one-lung ventilation in both thoracic surgery and other procedures, identifying the correct placement becomes increasingly important. Currently, endobronchial intubation is suspected based on a combination of auscultation and physiological findings. We investigated the ability of the visual display of airflow-induced vibrations to detect single-lung ventilation with a double-lumen endotracheal tube.

Methods Double-lumen tubes were placed prior to surgery. Tracheal and endobronchial lumens were alternately clamped to produce unilateral lung ventilation of right and left lung. Vibration response imaging, which detects vibrations transmitted to the surface of the thorax, was performed during both right- and left-lung ventilation. Geographical area of vibration response image as well as amount and distribution of lung sounds were assessed.

Results During single-lung ventilation, the image and video obtained from the vibration response imaging identifies the ventilated lung with a larger and darker image on the ventilated side. During single-lung ventilation, 87.2 ± 5.7% of the measured vibrations was detected over the ventilated lung and 12.8 ± 5.7% over the non-ventilated lung (P < 0.0001). It was also noted that during single-lung ventilation, the vibration distribution in the non-ventilated lung had a majority of vibration detected by the medial sensors closest to the midline (P < 0.05) as opposed to the midclavicular sensors when the lung is ventilated.

Conclusions During single-lung ventilation, vibration response imaging clearly showed increased vibration in the lung that is being ventilated. Distribution of residual vibration differed in the non-ventilated lung in a manner that suggests transmission of vibrations across the mediastinum from the ventilated lung. The lung image and video obtained from vibration response imaging may provide useful and immediate information to help one-lung ventilation assessment.

(Accepted March 26 2008)

Keywords

• INTUBATION INTRATRACHEAL;
• RESPIRATION ARTIFICIAL, one lung;
• IMAGING, vibration response imaging;
• PULMONARY VENTILATION, regional airflow distribution

Correspondence:

^c1 Correspondence to: Smith Jean, Department of Medicine, Division of Critical Care Medicine, Cooper University Hospital, Robert Wood Johnson School of Medicine, University of Medicine and Dentistry of New Jersey, One Cooper Plaza, Dorrance Building, Suite 393, Camden, NJ 08103, USA. E-mail: jean-smith@cooperhealth.edu; Tel: +856-342-2926; Fax: +856-968-8306