Massot Julien, Dumand-Nizard Virginie, Fischler Marc, Le Guen Morgan
Department of Anesthesiology and Intensive Care, Centre Hospitalier Universitaire Georges Pompidou, Paris, France; Université Paris Descartes, Paris, France.
Department of Anesthesiology, Hôpital Foch, Suresnes, France; Université Versailles Saint-Quentin en Yvelines, Suresnes, France.
J Cardiothorac Vasc Anesth. 2015 Dec;29(6):1544-9. doi: 10.1053/j.jvca.2015.04.031. Epub 2015 May 5.
VivaSight-DL (DLT-ETView) is a single-use double-lumen tube (DLT) with an integrated camera visualizing the carina continuously, which could reduce the need for a routine fiberoptic bronchoscopy. The objective of this study was to evaluate its rate of correct positioning.
A prospective, observational study.
A university hospital.
170 patients undergoing a thoracic surgical procedure.
Selective left bronchus intubation.
The main outcome measure was a double criteria assessed by fiberoptic bronchoscopy: the bronchial cuff in the left main bronchus and end of the bronchial lumen upstream of the lobar bifurcation. Between September 2013 and April 2014, 84 patients of the planned 170 were included. Seven patients were excluded: 3 for failed intubation, 3 for protocol violation, and 1 because the DLT melted before insertion. The study was terminated after this event. Seventy-six patients (99%) had correct positioning, with a median margin of safety of 20 mm (interquartile range: 15-27) in the surgical position. In 40 patients (53%), malpositioning required mobilization of the tube at least once intraoperatively.
The tube was well positioned in almost all patients. Continuous visualization of the carina is a major improvement for patient care as intraoperative displacement can be diagnosed immediately and corrected. However, an incident induced premature ending of the study.
VivaSight-DL(DLT-ETView)是一种一次性双腔支气管导管(DLT),带有一个集成摄像头可连续观察隆突,这可能会减少常规纤维支气管镜检查的需求。本研究的目的是评估其正确定位率。
一项前瞻性观察性研究。
一家大学医院。
170例接受胸外科手术的患者。
选择性左支气管插管。
主要结局指标是通过纤维支气管镜检查评估的双重标准:左主支气管内的支气管套囊以及叶间分叉上游支气管腔的末端。在2013年9月至2014年4月期间,计划纳入的170例患者中有84例被纳入研究。7例患者被排除:3例因插管失败,3例因违反方案,1例因双腔支气管导管在插入前熔化。此事件发生后研究终止。76例患者(99%)定位正确,在手术体位时安全 margin 的中位数为20 mm(四分位间距:15 - 27)。40例患者(53%)术中至少需要移动一次导管来纠正错位。
几乎所有患者的导管都定位良好。对隆突的连续观察是患者护理方面的一项重大改进,因为术中移位可立即被诊断并纠正。然而,一起事件导致研究提前结束。