El-Tahan Mohamed R
From the Department of Anaesthesia and Surgical ICU, King Fahd Hospital of the University of Dammam, Al Khubar, Saudi Arabia and Anaesthesiology Department, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt (MR-ET).
Eur J Anaesthesiol. 2015 Jun;32(6):411-7. doi: 10.1097/EJA.0000000000000194.
The use of the Arndt endobronchial blocker has not gained widespread acceptance during video-assisted thoracoscopic surgery (VATS) because of its high cost and longer time to operative lung collapse especially in patients with chronic obstructive pulmonary disease (COPD). The use of a ventilator disconnection technique has been shown to produce a comparable degree of lung collapse when used with either a double-lumen tube or an Arndt endobronchial blocker.
We hypothesised that the use of bronchial suction through the suction port of the endobronchial blocker would be associated with a comparable time to achieve optimum lung collapse as the disconnection technique.
A randomised, double-blind study.
Single university hospital.
Fifty-eight patients with spontaneous pneumothorax scheduled for elective VATS using the Arndt endobronchial blocker for one-lung ventilation (OLV).
Patients were randomly assigned to one of two groups (n = 29 per group) to deflate the operative lung with either disconnection of the endotracheal tube from the ventilator for 60 s prior to inflation of the endobronchial blocker or connection of a suction pressure of -30 cmH2O to the suction port of the endobronchial blocker through the barrel of a 1 ml syringe.
The primary outcome was the time to total lung collapse. Secondary outcomes included surgeon rating of lung collapse, overall surgeon satisfaction, need for further fibreoptic bronchial suction manoeuvres and intraoperative hypoxaemia.
The bronchial suction technique was associated with a significantly shorter time to total lung collapse than the disconnection method [93 (95% confidence interval, 95% CI 81.3 to 103.7) vs. 197 (95% CI 157.4 to 237) s respectively; P < 0.001]. Both the disconnection and bronchial suction groups had a comparable surgical rating of excellent lung collapse 40 min after the start of OLV (65.5 vs. 79.3%, respectively; P = 0.24), overall surgeon satisfaction [median (interquartile range, IQR) 9 (8 to 10) vs. 9 (8 to 10) respectively; P = 0.90] and intraoperative hypoxaemia (3.5 vs. 0%, respectively; P = 0.32). No patient in the bronchial suction group needed further manoeuvres to collapse the surgical lung. Moreover, the presence of COPD showed a significant positive correlation with the time to total lung collapse (Spearman r = 0.564; P < 0.001).
The use of continuous bronchial suction through the lumen of the Arndt blocker offers an effective method to accelerate lung collapse.
Clinicaltrials.gov identifier: NCT02030795.
由于阿恩特支气管内封堵器成本高且使手术侧肺萎陷所需时间较长，尤其是在慢性阻塞性肺疾病（COPD）患者中，其在电视辅助胸腔镜手术（VATS）中的应用尚未得到广泛认可。已证明，与双腔管或阿恩特支气管内封堵器联合使用时，采用呼吸机断开技术可产生相当程度的肺萎陷。
我们假设通过支气管内封堵器的吸引端口进行支气管吸引与断开技术实现最佳肺萎陷的时间相当。
一项随机双盲研究。
单一大学医院。
58例计划择期行VATS且使用阿恩特支气管内封堵器进行单肺通气（OLV）的自发性气胸患者。
患者被随机分为两组（每组n = 29），在支气管内封堵器充气前，一组将气管导管与呼吸机断开60秒以使手术侧肺萎陷，另一组通过1 ml注射器针筒将 -30 cmH₂O的吸引压力连接至支气管内封堵器的吸引端口。
主要观察指标为全肺萎陷时间。次要观察指标包括外科医生对肺萎陷的评分、外科医生总体满意度、进一步进行纤维支气管镜吸引操作的必要性以及术中低氧血症。
支气管吸引技术导致全肺萎陷的时间明显短于断开方法[分别为93（95%置信区间，95%CI 81.3至103.7）秒与197（95%CI 157.4至237）秒；P < 0.001]。在OLV开始40分钟后，断开组和支气管吸引组的手术肺萎陷良好评分相当（分别为65.5%与79.3%；P = 0.24），外科医生总体满意度[中位数（四分位间距，IQR）分别为9（8至10）与9（8至10）；P = 0.90]以及术中低氧血症发生率（分别为3.5%与0%；P = 0.32）。支气管吸引组中无患者需要进一步操作以使手术侧肺萎陷。此外，COPD的存在与全肺萎陷时间呈显著正相关（Spearman相关系数r = 0.564；P < 0.001）。
通过阿恩特封堵器管腔进行持续支气管吸引提供了一种加速肺萎陷的有效方法。
Clinicaltrials.gov标识符：NCT02030795。
