胸腔手术中使用视频双腔支气管导管与双腔支气管导管的随机对照研究。

A Randomized Controlled Study of the Use of Video Double-Lumen Endobronchial Tubes Versus Double-Lumen Endobronchial Tubes in Thoracic Surgery.

作者信息

Heir Jagtar Singh, Guo Shu-Lin, Purugganan Ronaldo, Jackson Tim A, Sekhon Anupamjeet Kaur, Mirza Kazim, Lasala Javier, Feng Lei, Cata Juan P

机构信息

Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.

Department of Anesthesiology, Cathay General Hospital, Taipei, Taiwan; Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan.

出版信息

J Cardiothorac Vasc Anesth. 2018 Feb;32(1):267-274. doi: 10.1053/j.jvca.2017.05.016. Epub 2017 May 9.

DOI:10.1053/j.jvca.2017.05.016

PMID:29074128

Abstract

OBJECTIVE

To compare the incidence of fiberoptic bronchoscope (FOB) use (1) during verification of initial placement and (2) for reconfirmation of correct placement following repositioning, when either a double-lumen tube (DLT) or video double-lumen tube (VDLT) was used for lung isolation during thoracic surgery.

DESIGN

A randomized controlled study.

SETTING

Single-center university teaching hospital.

PARTICIPANTS

The study comprised 80 patients who were 18 years or older requiring lung isolation for surgery.

INTERVENTIONS

After institutional review board approval, patients were randomized prior to surgery to either DLT or VDLT usage. Attending anesthesiologists placed the Mallinckrodt DLT or Vivasight (ET View Ltd, Misgav, Israel) VDLT with conventional laryngoscopy or video laryngoscopy then verified correct tube position through the view provided with either VDLT external monitor or FOB.

MEASUREMENTS AND MAIN RESULTS

Data collected included: sex, body mass index, successful intubation and endobronchial placement, intubation time, confirmation time of tube position, FOB use, quality of view, dislodgement of tube, and ability to forewarn dislodgement of endobronchial cuff and complications. FOB use for verification of final position of the tube (VDLT 13.2% [5/38] v DLT 100% [42/42], p < 0.0001), need for FOB to correct the dislodgement (VDLT 7.7% [1/13] v DLT 100% [14/14], p < 0.0001), dislodgement during positioning (VDLT 61.5% [8/13] v DLT 64.3% [9/14], p = ns), dislodgement during surgery (VDLT 38.5% [5/13] v DLT 21.4% [3/14], p = ns), and ability to forewarn dislodgement of endobronchial cuff (VDLT 18.4% [7/38] v DLT 4.8% [2/42], p = 0.078).

CONCLUSION

This study demonstrated a reduction of 86.8% in FOB use, which was a similar reduction found in other published studies.

摘要

目的

比较在胸外科手术中使用双腔气管导管（DLT）或可视双腔气管导管（VDLT）进行肺隔离时，（1）初次放置确认期间和（2）重新定位后再次确认正确放置时纤维支气管镜（FOB）的使用发生率。

设计

一项随机对照研究。

地点

单中心大学教学医院。

参与者

该研究纳入了80例18岁及以上需要进行肺隔离手术的患者。

干预措施

经机构审查委员会批准后，患者在手术前被随机分为使用DLT或VDLT。主治麻醉医生使用传统喉镜或可视喉镜放置Mallinckrodt DLT或Vivasight（ET View Ltd，米斯加夫，以色列）VDLT，然后通过VDLT外部监视器或FOB提供的视野确认导管位置正确。

测量指标和主要结果

收集的数据包括：性别、体重指数、插管成功和支气管内放置情况、插管时间、导管位置确认时间、FOB使用情况、视野质量、导管移位、支气管内套囊移位预警能力及并发症。用于确认导管最终位置的FOB使用情况（VDLT为13.2%[5/38]，DLT为100%[42/42]，p<0.0001），需要FOB纠正移位的情况（VDLT为7.7%[1/13]，DLT为100%[14/14]，p<0.0001），定位期间的移位情况（VDLT为61.5%[8/13]，DLT为64.3%[9/14]，p=无统计学意义），手术期间的移位情况（VDLT为38.5%[5/13]，DLT为21.4%[3/14]，p=无统计学意义），以及支气管内套囊移位预警能力（VDLT为18.4%[7/38]，DLT为4.8%[2/42]，p=0.078）。