全身麻醉支气管镜检查中发生的肺不张的发生率和部位：I-LOCATE 试验。
Incidence and Location of Atelectasis Developed During Bronchoscopy Under General Anesthesia: The I-LOCATE Trial.
机构信息
Department of Pulmonary Medicine, University of Texas MD Anderson Cancer Center, Houston, TX.
Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX.
出版信息
Chest. 2020 Dec;158(6):2658-2666. doi: 10.1016/j.chest.2020.05.565. Epub 2020 Jun 17.
BACKGROUND
Despite the many advances in peripheral bronchoscopy, its diagnostic yield remains suboptimal. With the use of cone-beam CT imaging we have found atelectasis mimicking lung tumors or obscuring them when using radial-probe endobronchial ultrasound (RP-EBUS), but its incidence remains unknown.
RESEARCH QUESTION
What are the incidence, anatomic location, and risk factors for developing atelectasis during bronchoscopy under general anesthesia?
STUDY DESIGN AND METHODS
We performed a prospective observational study in which patients undergoing peripheral bronchoscopy under general anesthesia were subject to an atelectasis survey carried out by RP-EBUS under fluoroscopic guidance. The following dependent segments were evaluated: right bronchus 2 (RB2), RB6, RB9, and RB10; and left bronchus 2 (LB2), LB6, LB9, and LB10. Images were categorized either as aerated lung ("snowstorm" pattern) or as having a nonaerated/atelectatic pattern. Categorization was performed by three independent readers.
RESULTS
Fifty-seven patients were enrolled. The overall intraclass correlation agreement among readers was 0.82 (95% CI, 0.71-0.89). Median time from anesthesia induction to atelectasis survey was 33 min (range, 3-94 min). Fifty-one patients (89%; 95% CI, 78%-96%) had atelectasis in at least one of the eight evaluated segments, 45 patients (79%) had atelectasis in at least three, 41 patients (72%) had atelectasis in at least four, 33 patients (58%) had atelectasis in at least five, and 18 patients (32%) had atelectasis in at least six segments. Right and left B6, B9, and B10 segments showed atelectasis in > 50% of patients. BMI and time to atelectasis survey were associated with increased odds of having more atelectatic segments (BMI: OR, 1.13 per unit change; 95% CI, 1.034-1.235; P = .007; time to survey: OR, 1.064 per minute; 95% CI, 1.025-1.105; P = .001).
INTERPRETATION
The incidence of atelectasis developing during bronchoscopy under general anesthesia in dependent lung zones is high, and the number of atelectatic segments is greater with higher BMI and with longer time under anesthesia.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov; No.: NCT03523689; URL: www.clinicaltrials.gov.
背景
尽管外周支气管镜检查有了许多进展，但它的诊断效果仍然不尽人意。我们使用锥形束 CT 成像发现，在使用径向探头支气管内超声（RP-EBUS）时，肺不张会模拟肺部肿瘤或使其变得模糊，但目前其发病率尚不清楚。
研究问题
全麻下支气管镜检查时，肺不张的发生率、解剖位置和危险因素是什么？
研究设计和方法
我们进行了一项前瞻性观察研究，对全麻下接受外周支气管镜检查的患者进行了由 RP-EBUS 在透视引导下进行的肺不张调查。评估了以下依赖段：右支气管 2（RB2）、RB6、RB9 和 RB10；以及左支气管 2（LB2）、LB6、LB9 和 LB10。图像分为充气肺（“暴风雪”模式）或不充气/肺不张模式。分类由三位独立的读者进行。
结果
共纳入 57 例患者。读者之间的总体组内相关系数为 0.82（95%置信区间，0.71-0.89）。从麻醉诱导到肺不张调查的中位时间为 33 分钟（范围，3-94 分钟）。51 例患者（89%；95%置信区间，78%-96%）在至少 8 个评估段中的一个部位存在肺不张，45 例患者（79%）存在至少 3 个部位的肺不张，41 例患者（72%）存在至少 4 个部位的肺不张，33 例患者（58%）存在至少 5 个部位的肺不张，18 例患者（32%）存在至少 6 个部位的肺不张。右和左 B6、B9 和 B10 段超过 50%的患者存在肺不张。BMI 和肺不张调查时间与存在更多肺不张段的几率增加相关（BMI：比值比，每单位变化 1.13；95%置信区间，1.034-1.235；P =.007；调查时间：比值比，每分钟增加 1.064；95%置信区间，1.025-1.105；P =.001）。
解释
全麻下支气管镜检查时，依赖区肺不张的发生率较高，BMI 较高和麻醉时间较长时，肺不张段数较多。
临床试验注册
ClinicalTrials.gov；编号：NCT03523689；网址：www.clinicaltrials.gov。
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