Abstract
Introduction Data on the feasibility and effects of single lung ventilation (SLV) in children
are scarce. We conducted a retrospective study on the feasibility of SLV during video-assisted
thoracoscopic surgery (VATS) in children and adolescents undergoing major thoracic
procedures.
Methods A retrospective chart review of all records from patients who underwent VATS at our
institution from 2000 to 2010 was done. Patients receiving SLV were analysed in detail.
Endpoints of the analysis were conversion to open thoracotomy (frequency and reasons),
postoperative duration of ventilation, and pulmonary complications such as radiologically
confirmed atelectasis and pneumonia.
Results 74 out of 305 patients (24%, 43 boys, 31 girls) with a mean age of 9.4 years (56
days–18 years) and mean weight of 34 kg (4.5–76 kg) had SLV. Lung resection was done
in 43 (58%), pleural surgery in 17 (23%), a combination of both in 7 (9%), and mediastinal
procedures in 7 (9%). 11 patients (15%) required conversion of VATS to open surgery,
mostly because of problems with exposure of the operative field (73%). 32 patients
(43%) were extubated immediately after the operation, whereas 8 (11%) required ventilation
for more than 24 h. The mean intensive care unit stay was 1.6 days. 18 patients (24%)
developed radiologically confirmed atelectasis, and 1 patient (1%) required bronchoscopic
clearance. Pneumonia occurred in 1 case (1%) and was successfully treated with antibiotics.
Conclusion SLV is feasible in children and adolescents undergoing VATS for a broad spectrum
of procedures. However, despite SLV, the conversion rate in our series was 15%. The
main reason for conversion was problems with exposure of the operative field. The
complication rate for SLV was low. Atelectasis developed in every fourth patient but
usually resolved spontaneously, and intervention to achieve ventilation was rarely
indicated.
Keywords
single lung ventilation (SLV) - video assisted thoracoscopic surgery (VATS) - children
