Volume-Controlled High-Frequency Positive-Pressure Ventilation as a Useful Mode of Ventilation during Open-Chest Surgery—A Report of Three Cases

We report three complicated cases of open-chest surgery in which volume-controlled high-frequency positive-pressure ventilation (HFPPV) was used because the low airway pressures and reduced intra-operative lung movement associated with this type of ventilation were considered desirable. The Siemens-Elema Bronchovent® Special ventilator was used at a frequency of 60/min, with inspiratory time occupying 22% of the ventilatory cycle. Ventilation (judged by Paco 2 ) was regulated by ventilator gas output (10-18 l/min), providing tidal volumes of 167 to 300 ml. Arterial oxygenation (judged by Pao 2 ) was adjusted by means of the inspired oxygen fraction (0.40-0.60) of the anesthetic gas mixture delivered by the ventilator. The cases reported are those of (1) a 61-year-old man requiring surgical resection of a thoracic aortic aneurysm, (2) a 61-year-old man requiring right-sided pneumonectomy for carcinoma, and (3) a 46-year-old man requiring repair of a bronchial fistula. HFPPV provided a favorable operating field and acceptable-to-good ventilation and oxygenation in all cases. All three patients were able to be extubated immediately following surgery.