Positional complications of endobronchial intubation due to tube displacement in the distal or proximal direction are also characteristic of single-lumen tubes. In addition, single-lung ventilation always violates the ventilation-perfusion ratio in the lungs with a corresponding increase in the volume of intrapulmonary shunting of blood, intensive accumulation of fluid in the lung parenchyma and a regular deterioration of gas exchange during surgery and in the early postoperative period. For the correction of marked circulatory and respiratory disorders in pulmonary resections in patients with advanced stages of lung cancer, it is advisable to combine endobronchial intubation with single-lung or separate lung ventilation with high-frequency ventilation (HF ALV). Such differentiated mechanical ventilation allows for effective gas exchange in almost any operation x on the lungs .

With extended resections of the lung, the HF ALV of the operated lung is performed in combination with the traditional ALV of the opposite lung. To do this, the injector of the HF ALV machine is connected to the duct of the double-lumen tube leading to the operated lung, or HF ALV is performed (frequency 150 — respiratory cycles per minute; inhalation: exhalation ratio 1: 2; PEEP not more than 4 cm cm of water) through a separate catheter inserted into the lumen of the trachea during intubation. This method has a high oxygenating ability, minimal impact on the volumetric blood flow velocity and, moreover, provides the most favorable conditions for the work of surgeons. The latter circumstance is very important — reducing the respiratory excursions of the operated lung not only facilitates the surgeon access to the anatomical structures of the lung root and mediastinum,but also protects the remaining part of the lung from excessive trauma.

However, the most important HF ALV is with a combined and, above all, tracheobronchial resections, when there is often a long opening of the lumen of the respiratory tract. Given the nature of surgical interventions in advanced stages of lung cancer, we are primarily talking about performing advanced pneumonectomy with resection of the side wall of the trachea, the wall of the trachea with the keel of the trachea bifurcation or circular resection of the trachea bifurcation and the initial section of the contralateral lung with tracheobronchial anastomosis.

Adoption of HF ALV the ability to perform such resections from

left-side access seemed highly questionable. In right-sided resections, the mouth of the main bronchus or the side wall of the trachea performed intubation of the left main bronchus. Tracheal wall resection and suturing were performed on the endobronchial tube. Then, pulling up the end of the tube proximal to the site of tracheal resection, they tightened and tied the ligatures. With more extensive resections of the tracheal wall, carina or bifurcation with the imposition of a tracheobronchial anastomosis from right-sided access, a “shunt-breathing” system was used with intubation through the operative wound of the left main bronchus through an additional incision in the membranous part of the bronchial wall. After performing resection and anastomosis, the lung ventilation was resumed through the endotracheal tube, and the defect in the membranous part was sutured.

Of course, the use of these methods is almost always accompanied by short periods of apnea and hypoventilation. In addition, the “shunt-breathing” system has a number of other drawbacks: the intubation tube, inserted from the surgical wound, prevents stitches during the formation of anastomoses, narrows the operative field, necessitates additional manipulations for bronchial intubation and, therefore, lengthens the time surgical intervention.

Currently, such operations use a combination of traditional and HF ALV. At the first stage of the operation, when performing thoracotomy, excretion of the lung, treatment of root vessels, the traditional lung ventilation of the opposite lung is used in combination with HF ALV of the operated lung or single lung ventilation with preliminary occlusion of the main bronchus of the operated lung. Before opening the lumen or trachea through the lumen of the endotracheal tube, a catheter 2– mm in diameter is inserted into the main bronchus of the contralateral lung and HF ALV is conducted through it during the entire period of tracheal resection and anastomosis. After the end of this stage, the catheter is removed, and the operation is completed through mechanical ventilation through the endotracheal tube.

When resections of the distal trachea from the left-sided access, we consider HF ALV as the alternative, the most rational and effective method of ensuring ventilation of the lungs. However, HF ALV, as well as all the methods mentioned, does not exclude the need for dynamic bronchoscopic control, the importance and benefit of which cannot be overestimated.