应用气管超声联合临床参数选择左侧双腔支气管导管型号：一项前瞻性观察性研究。

Use of tracheal ultrasound combined with clinical parameters to select left double-lumen tube size: A prospective observational study.

机构信息

From the Department of Anesthesiology and Intensive Care, C.H.U. Dijon (ER, PI, P-GG, BB, OD-R), Dijon and Université Bourgogne Franche-Comté, LNC UMR866, Dijon Cedex, France (P-GG, BB, OD-R), Anaesthesia and Intensive Care, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Policlinico San Matteo, Pavia, Italy (SM, FM) and Unit of Anaesthesia and Intensive Care, Department of Clinical-Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy (ER, FM).

出版信息

Eur J Anaesthesiol. 2019 Mar;36(3):215-220. doi: 10.1097/EJA.0000000000000939.

DOI:10.1097/EJA.0000000000000939

PMID:30540641

Abstract

BACKGROUND

Left double-lumen tubes (LDLTs) are used in thoracic surgery to allow one-lung ventilation. Their size is usually chosen on the basis of clinical parameters (height, sex). Double-lumen endobronchial tubes are frequently undersized/oversized, risking tube displacement or tracheal trauma. A correlation between ultrasound tracheal diameter and left main bronchus dimension has been demonstrated.

OBJECTIVES

We hypothesised that the insertion of undersized/oversized double-lumen tubes is frequent when the size is selected using standard criteria, and that the use of ultrasound to estimate tracheal diameter may help to reduce the frequency of insertion of oversized tubes.

DESIGN

Two-step prospective observational study.

SETTING

The operating room of a French University hospital from January 2016 to February 2017.

PATIENTS

We enrolled 102 and 50 consecutive patients undergoing elective thoracic surgery in Steps 1 and 2 (males 63.7 and 60.0%, age 63 (13) and 63 (11) years, height 170 (13) and 169 (9) cm, respectively).

INTERVENTION

In Step 1, the size of the LDLT inserted was selected on the basis of clinical parameters. Ultrasound data about tracheal diameter were collected to determine cut-off points associating height and tracheal diameter. Cut-off values for ultrasound tracheal diameter were applied retrospectively to test their capability to reduce the insertion rate of oversized tube. In Step 2, the LDLT size was chosen according to the determined combined cut-off values.

MAIN OUTCOME MEASURE

LDLT size was considered adequate if the bronchial cuff volume required for isolation of the lung (i.e. no difference between inspiratory and expiratory lung volumes) was 0.5 to 2.5 ml of air; undersized and oversized tubes required more than 2.5 ml and less than 0.5 ml, respectively.

RESULTS

In Step 1, LDLT size was appropriate/undersized/oversized in 40 (39.2%)/23 (22.6%)/39 (38.6%) of patients. Cut-off values derived from ultrasound measurements would have reduced the use of oversized tubes by 20.6% (P < 0.001). In Step 2, the frequency of use of adequately sized tubes increased (86.0 vs. 39.2%, P < 0.001), and the frequency of insertion of oversized and undersized tubes decreased (6.0 vs. 38.2% and 8.0 vs. 22.6%, both P < 0.001).

CONCLUSION

Combining ultrasound measurement of tracheal diameter and clinical parameters improves the choice of LDLT size.

摘要

背景

左双腔管（LDLT）用于胸外科以实现单肺通气。其尺寸通常基于临床参数（身高、性别）来选择。双腔支气管内导管经常尺寸过小/过大，有导管移位或气管创伤的风险。已经证明了超声气管直径与左主支气管尺寸之间存在相关性。

目的

我们假设使用标准标准选择尺寸时，插入过小/过大的双腔管很常见，并且使用超声估计气管直径可能有助于减少过大管的插入频率。

设计

两步前瞻性观察研究。

地点

法国大学医院的手术室，2016 年 1 月至 2017 年 2 月。

患者

我们在第 1 步和第 2 步中分别纳入了 102 例和 50 例连续接受择期胸外科手术的患者（男性分别为 63.7%和 60.0%，年龄分别为 63（13）和 63（11）岁，身高分别为 170（13）和 169（9）cm）。

干预

在第 1 步中，根据临床参数选择 LDLT 的尺寸。收集有关气管直径的超声数据，以确定与身高相关联的气管直径的截断值。将超声气管直径的截断值应用于回顾性测试，以检验其降低过大管插入率的能力。在第 2 步中，根据确定的联合截断值选择 LDLT 尺寸。

主要观察指标

如果支气管袖套所需的隔离肺所需的空气体积（即吸气和呼气肺容积之间无差异）为 0.5 至 2.5ml，则认为 LDLT 尺寸合适/过小/过大；需要超过 2.5ml 和小于 0.5ml 的分别为过小和过大的管。

结果

在第 1 步中，40 例（39.2%）/23 例（22.6%）/39 例（38.6%）患者的 LDLT 尺寸合适/过小/过大。超声测量得出的截断值将使过大管的使用减少 20.6%（P<0.001）。在第 2 步中，合适尺寸管的使用频率增加（86.0%比 39.2%，P<0.001），而过大管和小管的插入频率降低（6.0%比 38.2%和 8.0%比 22.6%，均 P<0.001）。