High-frequency jet ventilation using the arndt bronchial blocker for refractory hypoxemia during one-lung ventilation in a myasthenic patient with asthma

Abstract

A novel method in the management of refractory severe hypoxemia during one-lung ventilation (OLV) in a patient who presented with myasthenia gravis, asthma, a symptomatic mediastinal mass, hiatal hernia, and a moderate pericardial effusion is presented. The patient was scheduled for excision of a large anterior mediastinal mass and creation of a pericardial window through a left thoracotomy. One-lung ventilation was achieved using an Arndt bronchial blocker. Highfrequency jet ventilation (HFJV) was applied to the surgical nondependent lung through the lumen of the Arndt endobronchial blocker with titration of positive end-expiratory pressure to the dependent lung. Oxygenation improved significantly. The use of HFJV through the Arndt blocker offers an effectivemethod for treatment of refractory hypoxemia during OLV.