Department of Pulmonary and Critical Care Medicine, Second Affiliated Hospital of Fujian Medical University, Respiratory Medicine Center of Fujian Province, No. 34, Zhongshanbei Road, Licheng District, Quanzhou 362000, Fujian Province, China.
Department of Pulmonary and Critical Care Medicine, Second Affiliated Hospital of Fujian Medical University, Respiratory Medicine Center of Fujian Province, China.
Ther Adv Respir Dis. 2018 Jan-Dec;12:1753465818756564. doi: 10.1177/1753465818756564.
Location of the affected bronchus of pleural air leaks is the most important step of trans-bronchoscopic bronchial occlusion for the treatment of intractable pneumothorax. The balloon occlusion test is the most commonly used technique, but has failed in some cases. The aim of the present study was: (1) to determine if endo-bronchial end-tidal CO (EtCO) measurement can identify the affected bronchus that is the source of a persistent pleural air leak; and (2) to establish a methodology for endo-bronchial EtCO testing in locating affected bronchus in intractable pneumothorax.
A total of 28 patients with intractable pneumothorax underwent bronchoscopy with (1) the balloon occlusion test for the identification of the affected bronchus; and (2) endo-bronchial EtCO measurement (EtCO test) at the orifices of the bronchus of the affected lung. The effectiveness of these two methods of affected bronchus identification were compared. The threshold EtCO (T-EtCO) was determined.
The positive rates of locating the affected bronchus by the endo-bronchial EtCO test, balloon occlusion test, and combination of the two techniques were 60.7% (17/28), 64.3% (18/28) and 96.4% (27/28), respectively. The average differences in EtCO between the affected bronchus and the main carina, main bronchus, and non-affected bronchus were (in mmHg) 4.41 ± 1.99 (95% confidence interval: 3.5, 5.3), 4.73 ± 2.10 (3.80, 5.66 ) and 5.57 ± 2.53 (4.45, 6.69), respectively.
(1) The endo-bronchial EtCO test is complementary to the balloon occlusion test of the leading bronchus. (2) A threshold (T-EtCO) value of >5 mmHg is optimal for this technique.
胸腔漏气的受累支气管的位置是经支气管镜支气管阻塞治疗难治性气胸最重要的步骤。球囊阻塞试验是最常用的技术，但在某些情况下失败了。本研究的目的是：（1）确定支气管内呼气末 CO（EtCO）测量是否可以确定持续性胸腔漏气的受累支气管；（2）建立经支气管内 EtCO 检测定位难治性气胸受累支气管的方法。
共 28 例难治性气胸患者行支气管镜检查，（1）球囊阻塞试验确定受累支气管；（2）受累肺支气管口行支气管内 EtCO 测量（EtCO 试验）。比较两种受累支气管识别方法的有效性。确定阈值 EtCO（T-EtCO）。
支气管内 EtCO 试验、球囊阻塞试验和两种技术联合定位受累支气管的阳性率分别为 60.7%（28/28）、64.3%（28/28）和 96.4%（27/28）。受累支气管与主隆突、主支气管和非受累支气管的 EtCO 差值平均值（mmHg）分别为（4.41±1.99）（95%置信区间：3.5，5.3）、（4.73±2.10）（3.80，5.66）和（5.57±2.53）（4.45，6.69）。
（1）支气管内 EtCO 试验是主导支气管球囊阻塞试验的补充。（2）T-EtCO 值>5mmHg 是该技术的最佳选择。
