The Therapeutic Potential of Intraoperative Hypercapnia During Video-Assisted Thoracoscopy in Pediatric Patients

Abstract

Hypercapnia targeting CO2 50-70 mm Hg was associated with increased cardiac output, central venous O2, and arterial O2 tension in patients undergoing video-assisted thoracoscopic patent ductus arteriosus closure using one-lung ventilation without any deleterious cardiopulmonary effects.

Thoracoscopic repair of congenital diaphragmatic hernia: intraoperative ventilation and recurrence

“…Gentili et al [4] demonstrated an increase in EtCO 2 during thoracoscopy in children, with associated decrease in systolic and diastolic blood pressure. Mukhtar et al [5] suggested a beneficial effect of hypercapnia by increasing cardiac output in a group of children having thoracoscopic patent ductus ligation. The balance of cardiovascular effects in the presence of persistent pulmonary hypertension in CDH is not clear.…”

“…For example, CO 2 is absorbed during insufflation into the chest and creation of a capnothorax [2,3], which can lead to significant metabolic and physiologic changes. These include a degree of right-to-left shunting, decreased venous return and cardiac output, and systemic hypertension or hypotension depending on complex interactions [4,5]. The impaired respiratory capacity imposed by lung collapse has significant implications for oxygenation and CO 2 excretion [6] and increase in arterial-alveolar CO 2 gradient [7].…”

Intraoperative Bronchopleural Fistula During Thoracoscopic Lobectomy

“…Indeed, hypercapnia during VATS has been shown to have some hemodynamic benefit. 7 This mild-tomoderate hypercapnia can usually be remedied by slightly increased respiratory rate. Our patient developed a rapid, supraphysiologic increase in ETCO 2 and became progressively hypotensive.…”

The Different Approaches of Single Lung Ventilation in Infants with Pulmonary Malformation

“…While some surgeons might minimize the procedure ("only three small holes"), parents must know that, along with the benefits, there are also some risks whose frequency and severity must be explained. Minimally invasive surgery does not mean minimal risk [19].…”

“…A large bore intravenous access is mandatory, since the time necessary to stop bleeding from a large vessel is longer in VATS than in open surgery [19].…”