Objective The benefits and risks of using double lumen tube (DLT) in open thoracotomy are not well studied and the relative contraindication for using it in cases of endobronchial tumours is not proven. In this study,...Objective The benefits and risks of using double lumen tube (DLT) in open thoracotomy are not well studied and the relative contraindication for using it in cases of endobronchial tumours is not proven. In this study, we compared our experience with using DLT versus single lumen tube (SLT) for anesthesia in patients requiring an open thoracotomy for resection of endobronchial tumours. Methods A prospective observational study was performed in a single tertiary care university hospital in patients with endobronchial tumours anesthetized with single and double lumen tubes for open thoracotomy procedures over a period from 2010 till 2018. Results One hundred and six patients with endobronchial tumours were studied. There were 76 males. Median age was 32 years (14 - 62). In 96 cases, endobronchial pathology was a typical carcinoid. 58 patients were anesthetized using a DLT and 48 using a SLT. Four cases of near miss from potentially fatal intraoperative tumour migration occurred in the SLT group (p = 0.025). There was only one case of mild tumour bleeding from the DLT group and time of insertion was longer (16.2 vs. 4.5 min p Conclusions We conclude that it is safe to place a double lumen endo tracheal tube for patients with endobronchial tumours requiring open lobectomies or bronchoplastic procedures. An additional benefit of DLT use is increasing surgical satisfaction by reducing spillage and tidal volume loss during surgical anastomosis of the open airway.展开更多
目的 探讨单双肺气道压差值(airway pressure differences between one lung and two lung ventilation,ΔP)指导双腔气管导管(double lumen tube,DLT)插管定位的效率及肺隔离效果。方法 选取2021年11月至2022年10月北京协和医院胸外科...目的 探讨单双肺气道压差值(airway pressure differences between one lung and two lung ventilation,ΔP)指导双腔气管导管(double lumen tube,DLT)插管定位的效率及肺隔离效果。方法 选取2021年11月至2022年10月北京协和医院胸外科拟在单肺通气下手术的患者396例,患者随机分为纤维支气管镜(fiber optical bronchoscopy,FOB)组和ΔP组,每组198例,FOB组采用FOB定位DLT,ΔP组采用ΔP定位DLT。比较两组侧卧位后DLT调整时间、DLT插管时间、SpO_(2)及肺塌陷效果满意度。结果 396例患者中,男203例,女193例,年龄36~69岁,平均(56.8±4.8)岁。ΔP组侧卧位后DLT调整时间短于FOB组[(37.73±14.06)s比(51.76±15.74)s],差异有统计学意义(P<0.05);两组DLT插管时间、SpO_(2)、肺塌陷效果满意度的比较,差异均无统计学意义(P>0.05)。结论 ΔP具有操作时间短、较高DLT定位成功率和较好单肺通气肺塌陷效果等优势,尤其在FOB缺少时,ΔP可作为DLT插管定位的新方法。展开更多
Background: One-lung ventilation (OLV) is generally adopted for thoracic surgery. The systemic application of a high fraction of inspiratory oxygen (F<sub>1</sub>O<sub>2</sub>) and continuous p...Background: One-lung ventilation (OLV) is generally adopted for thoracic surgery. The systemic application of a high fraction of inspiratory oxygen (F<sub>1</sub>O<sub>2</sub>) and continuous positive airway pressure (CPAP) to the non-ventilated lung is useful for preventing arterial oxygen desaturation. The adverse effects of elevated F<sub>1</sub>O<sub>2</sub> include oxidative lung injury, resorption atelectasis and coronary and peripheral vasoconstriction. It is preferable to avoid hyperoxemia in patients with complications such as chronic obstructive pulmonary disease, idiopathic pneumonia, and bleomycin-treated lungs. We aimed to determine whether the application of 60% O<sub>2</sub> CPAP to the non-ventilated lung is sufficient to provide adequate oxygenation with 60% O<sub>2</sub> to the ventilated lung. Methods: A total of 70 patients scheduled to receive elective thoracic surgery requiring OLV were recruited. Left double-lumen tubes were applicable in all surgeries. Patients were randomly allocated to one of two groups, to receive either 60% O<sub>2</sub> CPAP (60% CPAP group, n = 35), or 100% O<sub>2</sub> CPAP (100% CPAP group, n = 35) at a setting of 2 - 3 cmH<sub>2</sub>O, applied to the non-ventilated lung. Arterial blood gas analyses were obtained at the following stages: RA, spontaneous breathing under room air (RA);TLV, during total lung ventilation (TLV) prior to the initiation of OLV;T5, 5 min after the initiation of OLV;T15, 15 min after the initiation of OLV;T30, 30 min after the initiation of OLV. Results: The PaO<sub>2</sub> value in 60% CPAP group vs. 100% CPAP group at each measurement were as follows: RA (mean [standard deviation: SD], 89.7 [8.2] mmHg vs. 85.8 [11.9] mmHg);TLV (277.9 [52.9] mmHg vs. 269.2 [44.0] mmHg);T5 (191.4 [67.9] mmHg vs. 192.3 [66.0] mmHg);T15 (143.2 [67.3] mmHg vs. 154.7 [60.8] mmHg) and T30 (95.6 [32.0] mmHg vs. 112.5 [36.5] mmHg), respectively. Among the five measurement points, T30 was the only time point at which the 100% CPAP group showed a significantly greater PaO<sub>2</sub> value than the 60% CPAP group (p = 0.0495). The SaO<sub>2</sub> at T30 in the 100% CPAP group (97.4 [2.0]%) was also significantly greater than that in the 60% CPAP group (96.3 [2.2]%, p = 0.039). No differences were found between the groups regarding changes to the overall PaO<sub>2</sub> values (p = 0.44) and SaO<sub>2</sub> values (p = 0.23) during the study period. Conclusions: Oxygenation could be safely maintained in relatively healthy patients with 60% O<sub>2</sub> OLV and 60% O<sub>2</sub> CPAP. The application of 60% O<sub>2</sub> CPAP during OLV for patients who are not suited to exposure to high F<sub>1</sub>O<sub>2</sub> may be an alternative form of respiratory management.展开更多
文摘Objective The benefits and risks of using double lumen tube (DLT) in open thoracotomy are not well studied and the relative contraindication for using it in cases of endobronchial tumours is not proven. In this study, we compared our experience with using DLT versus single lumen tube (SLT) for anesthesia in patients requiring an open thoracotomy for resection of endobronchial tumours. Methods A prospective observational study was performed in a single tertiary care university hospital in patients with endobronchial tumours anesthetized with single and double lumen tubes for open thoracotomy procedures over a period from 2010 till 2018. Results One hundred and six patients with endobronchial tumours were studied. There were 76 males. Median age was 32 years (14 - 62). In 96 cases, endobronchial pathology was a typical carcinoid. 58 patients were anesthetized using a DLT and 48 using a SLT. Four cases of near miss from potentially fatal intraoperative tumour migration occurred in the SLT group (p = 0.025). There was only one case of mild tumour bleeding from the DLT group and time of insertion was longer (16.2 vs. 4.5 min p Conclusions We conclude that it is safe to place a double lumen endo tracheal tube for patients with endobronchial tumours requiring open lobectomies or bronchoplastic procedures. An additional benefit of DLT use is increasing surgical satisfaction by reducing spillage and tidal volume loss during surgical anastomosis of the open airway.
文摘目的 探讨单双肺气道压差值(airway pressure differences between one lung and two lung ventilation,ΔP)指导双腔气管导管(double lumen tube,DLT)插管定位的效率及肺隔离效果。方法 选取2021年11月至2022年10月北京协和医院胸外科拟在单肺通气下手术的患者396例,患者随机分为纤维支气管镜(fiber optical bronchoscopy,FOB)组和ΔP组,每组198例,FOB组采用FOB定位DLT,ΔP组采用ΔP定位DLT。比较两组侧卧位后DLT调整时间、DLT插管时间、SpO_(2)及肺塌陷效果满意度。结果 396例患者中,男203例,女193例,年龄36~69岁,平均(56.8±4.8)岁。ΔP组侧卧位后DLT调整时间短于FOB组[(37.73±14.06)s比(51.76±15.74)s],差异有统计学意义(P<0.05);两组DLT插管时间、SpO_(2)、肺塌陷效果满意度的比较,差异均无统计学意义(P>0.05)。结论 ΔP具有操作时间短、较高DLT定位成功率和较好单肺通气肺塌陷效果等优势,尤其在FOB缺少时,ΔP可作为DLT插管定位的新方法。
文摘Background: One-lung ventilation (OLV) is generally adopted for thoracic surgery. The systemic application of a high fraction of inspiratory oxygen (F<sub>1</sub>O<sub>2</sub>) and continuous positive airway pressure (CPAP) to the non-ventilated lung is useful for preventing arterial oxygen desaturation. The adverse effects of elevated F<sub>1</sub>O<sub>2</sub> include oxidative lung injury, resorption atelectasis and coronary and peripheral vasoconstriction. It is preferable to avoid hyperoxemia in patients with complications such as chronic obstructive pulmonary disease, idiopathic pneumonia, and bleomycin-treated lungs. We aimed to determine whether the application of 60% O<sub>2</sub> CPAP to the non-ventilated lung is sufficient to provide adequate oxygenation with 60% O<sub>2</sub> to the ventilated lung. Methods: A total of 70 patients scheduled to receive elective thoracic surgery requiring OLV were recruited. Left double-lumen tubes were applicable in all surgeries. Patients were randomly allocated to one of two groups, to receive either 60% O<sub>2</sub> CPAP (60% CPAP group, n = 35), or 100% O<sub>2</sub> CPAP (100% CPAP group, n = 35) at a setting of 2 - 3 cmH<sub>2</sub>O, applied to the non-ventilated lung. Arterial blood gas analyses were obtained at the following stages: RA, spontaneous breathing under room air (RA);TLV, during total lung ventilation (TLV) prior to the initiation of OLV;T5, 5 min after the initiation of OLV;T15, 15 min after the initiation of OLV;T30, 30 min after the initiation of OLV. Results: The PaO<sub>2</sub> value in 60% CPAP group vs. 100% CPAP group at each measurement were as follows: RA (mean [standard deviation: SD], 89.7 [8.2] mmHg vs. 85.8 [11.9] mmHg);TLV (277.9 [52.9] mmHg vs. 269.2 [44.0] mmHg);T5 (191.4 [67.9] mmHg vs. 192.3 [66.0] mmHg);T15 (143.2 [67.3] mmHg vs. 154.7 [60.8] mmHg) and T30 (95.6 [32.0] mmHg vs. 112.5 [36.5] mmHg), respectively. Among the five measurement points, T30 was the only time point at which the 100% CPAP group showed a significantly greater PaO<sub>2</sub> value than the 60% CPAP group (p = 0.0495). The SaO<sub>2</sub> at T30 in the 100% CPAP group (97.4 [2.0]%) was also significantly greater than that in the 60% CPAP group (96.3 [2.2]%, p = 0.039). No differences were found between the groups regarding changes to the overall PaO<sub>2</sub> values (p = 0.44) and SaO<sub>2</sub> values (p = 0.23) during the study period. Conclusions: Oxygenation could be safely maintained in relatively healthy patients with 60% O<sub>2</sub> OLV and 60% O<sub>2</sub> CPAP. The application of 60% O<sub>2</sub> CPAP during OLV for patients who are not suited to exposure to high F<sub>1</sub>O<sub>2</sub> may be an alternative form of respiratory management.
