Saporito Andrea, Lo Piccolo Antonio, Franceschini Daniele, Tomasetti Renato, Anselmi Luciano
Anesthesia Service, Bellinzona Regional Hospital, 6500 Bellinzona, Switzerland.
J Ultrasound. 2013 Nov 9;16(4):195-9. doi: 10.1007/s40477-013-0050-9.
Fiberoptic bronchoscopy is the standard method for verifying the correct position of a double-lumen endotracheal tube (DLET) prior to one-lung ventilation. However, it must be performed by a specially trained anesthesiologist and is often resource consuming. The aim of this study was to compare this approach with thoracic ultrasound done by a nurse anesthetist in terms of sensitivity, specificity, and cost-effectiveness.
We conducted a prospective cross-over case-control study involving 51 adult patients consecutively undergoing thoracic surgery with one-lung ventilation. After orotracheal intubation with a DLET, correct exclusion of the lung being operated on exclusion was assessed first by a certified anesthesiologist using standard fiberoptic bronchoscopy and then by a trained nurse anesthetist using thoracic ultrasound. The nurse was blinded as to the findings of the anesthesiologist's examination.
The two approaches proved to be equally sensitive and specific, but the ultrasound examination was more rapid. This factor, together with the fact that ultrasound was performed by a nurse instead of a physician, and the costs of materials and sterilization, had a significant economic impact amounting to a net saving of €37.20 ± 5.40 per case.
Although fiberoptic bronchoscopy is still the gold standard for checking the position of a DLET, thoracic ultrasound is a specific, sensitive, cost-effective alternative, which can be used to rapidly verify the proper function of the tube based on the demonstration of correct lung exclusion.
纤维支气管镜检查是在单肺通气前确认双腔气管导管（DLET）正确位置的标准方法。然而，它必须由经过专门培训的麻醉医生进行，且通常耗费资源。本研究的目的是在敏感性、特异性和成本效益方面，将这种方法与由麻醉护士进行的胸部超声检查进行比较。
我们进行了一项前瞻性交叉病例对照研究，纳入了51例连续接受单肺通气胸外科手术的成年患者。在经口插入DLET后，首先由一名经过认证的麻醉医生使用标准纤维支气管镜评估是否正确排除了手术侧肺，然后由一名经过培训的麻醉护士使用胸部超声进行评估。该护士对麻醉医生的检查结果不知情。
两种方法的敏感性和特异性相同，但超声检查更快。这一因素，再加上超声检查由护士而非医生进行，以及材料和消毒成本，产生了显著的经济影响，每例净节省37.20±5.40欧元。
虽然纤维支气管镜检查仍是检查DLET位置的金标准，但胸部超声是一种特异性、敏感性高且具有成本效益的替代方法，可基于正确排除肺的表现快速验证导管的正常功能。
