Department of Thoracic Surgery, Sapporo Medical University, School of Medicine and Hospital, Sapporo, Hokkaido, Japan.
Department of Anesthesiology, Sapporo Medical University, School of Medicine and Hospital, Sapporo, Hokkaido, Japan.
J Surg Res. 2021 Jan;257:344-348. doi: 10.1016/j.jss.2020.08.017. Epub 2020 Sep 3.
The movement of a double-lumen endotracheal tube (DLT) out of its appropriate position during thoracic surgery can result in the loss of one-lung ventilation (OLV), especially during pulmonary resection and node dissection. Our study aimed to validate the efficacy of automatic retention pressure control of the DLT bronchial cuff in maintaining OLV in an artificial intubation model.
A 35-Fr left-sided DLT was intubated to the left main bronchus in an intubation simulator and connected to an anesthesia machine. The inspiratory volume, respiratory rate, and inspiratory-expiratory ratio were set at 500 mL, 12 times/min, and 1:2, respectively. A 1-kg right main bronchial traction in the lateral right was provided after OLV was established. SmartCuff (Smiths Medical, Minneapolis, Minnesota, USA) was used to maintain cuff pressure. The efficacy of retention pressure with SmartCuff (Group S) and without SmartCuff (Group WS) was compared. The primary outcome was the rate of tidal volume (TV) reduction following bronchial traction in the two groups.
The TVs were 289.8 ± 28.9 mL and 242.8 ± 31.9 mL in Group S and Group WS, respectively (P = 0.003). The rate of TV reduction after bronchial traction was significantly lower in Group S (29 ± 5%) than in Group WS (43 ± 6%) (P < 0.001).
Automatic retention pressure control of the DLT bronchial cuff improves the rate of TV reduction during right main bronchial traction in an artificial intubation model. Continuous retention cuff pressure may be useful in maintaining OLV during thoracic surgery.
在胸外科手术中，双腔气管导管（DLT）移出其适当位置会导致单肺通气（OLV）丧失，尤其是在肺切除和淋巴结清扫期间。我们的研究旨在验证 DLT 支气管套囊自动保持压力控制在人工插管模型中维持 OLV 的效果。
将 35Fr 左侧 DLT 插管插入左侧主支气管，并与麻醉机连接。吸气量、呼吸频率和吸呼比分别设置为 500mL、12 次/分钟和 1:2。在建立 OLV 后，在右侧提供 1kg 右侧主支气管侧向牵引。使用 SmartCuff（Smiths Medical，明尼苏达州明尼阿波利斯，美国）维持套囊压力。比较 SmartCuff 保留压力组（Group S）和无 SmartCuff 保留压力组（Group WS）的效果。主要结果是两组支气管牵引后潮气量（TV）减少率。
Group S 和 Group WS 的 TV 分别为 289.8±28.9mL 和 242.8±31.9mL（P=0.003）。支气管牵引后 TV 减少率在 Group S（29±5%）明显低于 Group WS（43±6%）（P<0.001）。
DLT 支气管套囊自动保持压力控制可降低人工插管模型中右侧主支气管牵引时 TV 减少率。持续保持套囊压力可能有助于维持胸外科手术中的 OLV。
