| English |
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| Title | Continuous Monitoring of Arterial Blood Gas during Bronchopulmonary Lavage for Pulmonary Alveolar Proteinosis |
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| Subtitle | |
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| Authors | Hiroshi Sakamoto*1, Yoshitada Ito*2, Hiroshi Kawahigashi*3, Hideyuki Mashio*3, Yukiko Goda*3, Takahisa Mayumi*2, Osamu Kemmotsu*2 |
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| Authors(kana) | |
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| Organization | *1Department of Anesthesia Cardiovascular Center Hokkaido Ohno hospital, *2Department of Anesthesiology, Hokkaido University School of Medicine, *3Department of Anesthesia, Sapporo City General Hospital |
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| Journal | Circulation Control |
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| Volume | 19 |
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| Number | 2 |
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| Page | 274-278 |
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| Year/Month | 1998/ |
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| Article | Report |
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| Publisher | Japan Society of Circulation Control |
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| Abstract | [Abstract] Pulmonary proteinosis is a rare lung disorder in which an amorphous proteinaceous material is deposited in alveoli and bronchioli. Bronchopulmonary lavage (BPL) is the only successful treatment. We had a case with pulmonary proteinosis scheduled for BPL under general anesthesia. Anesthesia was induced with fentanyl and thiamylal. The trachea was intubated with a double lumen tube following vecuronium. Anesthesia was maintained with sevoflurane in oxygen. An arterial cannula with a sensor tip, a pulmonary artery catheter and a pulse oximeter were placed to monitor arterial blood pH, PaO2, PaCO2, mixed venous oxygen saturation (SVO2), pulse oxymetry (SPO2), arterial blood pressure, pulmonary and central venous pressure and cardiac index continuously. Physiological saline was infused into the washing lung by a pressure of 30cmH2O and drained by -60cmH2O. After BPL, mechanical ventilation was continued for 18 hours. Right and left ventricular stroke work indices (RVSWI and LVSWI), systemic and pulmonary vascular resistance indices (SVRI, PVRI), oxygen delivery index (DO2I), oxygen consumption(VO2), alveolar to arterial oxygen tension difference(DAaO2), alveolar to arterial blood oxygen tension difference(CaVO2) and intrapulmonary shunt (Qs/Qt) were calculated. PAP, CVP, PaO2, SPO2, and SVO2 increased by the instillation of fluid while they were vice versa by the drainage. During the instillation, the increased intraalveolar pressure caused the diversion of pulmonary blood flow to the ventilated lung. Drainage reversed these changes. PaO2, SPO2 and SVO2, indicate blood oxygenation. The change of PaO2 is the quickest and most among them. Because arterial oxygenation changes quickly during BPL, the placement of an arterial cannula with a continuous blood gas analysis sensor is useful. |
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| Practice | Basic medicine |
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| Keywords | Continuous arterial blood gas analysis, Bronchopulmonary lavage, Unilateral whole lung lavage, Pulmonary proteinosis. |
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