Ventilation with a low tidal volume vs. an intermediate tidal volume during pleural decortication. Annali italiani di chirurgia OBJECTIVE:This study aims to evaluate the effects of low tidal volume and positive end expiratory pressure (PEEP) combined with pressure-controlled ventilation-volume guaranteed (PCV-VG) ventilation on one lung ventilation (OLV) in patients with tuberculous destroyed lung (TDL). METHODS:Patients of two groups were all treated with volume controlled ventilation (VCV) on two-lung ventilation, and the tidal volume was set to 8 ml/kg according to standard body weight, breath rate was set to 10-14 times/min, inspiration and expiration ratio was set to 1:1.5. During OLV, VCV was used in group C, and the tidal volume was set to 8 ml/kg; PCV-VG was given to group P patients, and the tidal volume was set to 6 ml/kg, followed by PEEP at 7 cm H2O. Breath rate was set to 12-16 times/min, and inspiration and expiration ratio was set to 1:1.5 in both groups on OLV. RESULTS:Pplat, Ppeak and intrapulmonary shunt (Qs/Qt) were lower at T2 and T3 in group P, when compared to group C (P<0.05). At T2, T3 and T4, the oxygenation index (OI) increased, Qs/Qt decreased and arterial carbon dioxide partial pressure (PaCO2) increased in group P (P<0.05). At T5, the concentration of IL-6, TNF-α and BNP decreased in group P. CONCLUSION:Low tidal volume and PEEP combined with PCV-VG ventilation might be helpful for alleviating pulmonary injury in OLV, and reducing airway pressure and Qs/Qt during OLV in surgery. KEY WORDS:Destroyed lung, Low tidal volume, Low tidal volume, Positive end-expiratory pressure, Pressure-controlled ventilation, One lung ventilation.

Very low tidal volume, high-frequency ventilation in atrial fibrillation ablation: a systematic review. Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing BACKGROUND:Ventilation strategies in atrial fibrillation ablation affect procedure outcomes by influencing catheter stability. Studies have highlighted favorable atrial fibrillation (AF) ablation outcomes with the use of high-frequency jet ventilation (HFJV) which has been shown to improve lesion durability, energy delivery, and tissue contact. However, this mode of ventilation is not readily available. In this systematic review, we highlight the available data on the use of very low tidal volume, high-frequency ventilation using standard ventilators that aim to provide settings similar to HFJV during AF ablations. METHODS:Using a combination of search terms in databases and manual searches in bibliographies of identified articles, we reviewed all published data reported in the English language on the use of very low tidal volume with high-frequency ventilation during atrial fibrillation ablation. RESULTS:A total of 4 manuscripts were identified; 3 cohort studies and 1 case report. The utilization of standard ventilators with a high-frequency, very low tidal volume ventilation strategy appears to closely mimic the catheter stability benefits that HFJV ventilators provide. Across the 3 cohort identified studies, the use of this ventilation strategy was associated with improved catheter stability, tissue contact, and a decrease in radiofrequency time. No increased risk was identified compared to standard ventilation. CONCLUSION:With a purpose of limiting thoracic excursion and cardiac movement, limited and sparse studies have shown improved outcomes with a very low tidal volume, high-frequency ventilation strategy. Additional studies are needed to solidify this easily accessible and widely available mode of ventilation. 10.1007/s10840-022-01123-1