Department of Anesthesiology and Critical Care, Université Laval, Quebec City, QC, Canada.
Department of Anesthesiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval, 2725, Chemin Sainte-Foy, Quebec City, QC, G1V 4G5, Canada.
Can J Anaesth. 2021 Jun;68(6):791-800. doi: 10.1007/s12630-021-01938-y. Epub 2021 Feb 16.
Double-lumen endotracheal tubes (DL-ETT) and bronchial blockers (BB) are frequently used to allow one-lung ventilation (OLV) during video-assisted thoracic surgery (VATS). Recently, faster lung collapse has been documented with a BB than with a DL-ETT. The physiologic mechanisms behind this faster collapse remained unknown. We aimed to measure ambient air absorption (V) and intra-bronchial pressure (P) into the non-ventilated lung during OLV using DL-ETT and BB.
Patients undergoing VATS and OLV for lung resection were randomly assigned to have measurements made of V or P within the non-ventilated lung using either a DL-ETT or BB.
Thirty-nine patients were included in the analyses. The mean (standard error of the mean [SEM]) V was similar in the DL-ETT and BB groups [504 (85) vs 630 (86) mL, respectively; mean difference, 126; 95% confidence interval [CI], -128 to 380; P = 0.31]. The mean (SEM) P became progressively negative in the non-ventilated lung in both the DL-ETT and the BB groups reaching [-20 (5) and -31 (10) cmHO, respectively; mean difference, -11; 95% CI, -34 to 12; P = 0.44] at the time of the pleural opening.
During OLV before pleural opening, entrainment of ambient air into the non-ventilated lung occurs when the lumen of the lung isolation device is kept open. This phenomenon is prevented by occluding the lumen of the isolation device before pleural opening, resulting in a progressive build-up of negative pressure in the non-ventilated lung. Future clinical studies are needed to confirm these physiologic results and their impact on lung collapse and operative outcomes.
www.clinicaltrials.gov (NCT02919267); registered 28 September 2016.
双腔气管导管（DL-ETT）和支气管阻塞器（BB）常用于电视辅助胸腔镜手术（VATS）期间的单肺通气（OLV）。最近，有研究记录到 BB 比 DL-ETT 能更快地使肺萎陷。导致这种更快萎陷的生理机制尚不清楚。我们旨在使用 DL-ETT 和 BB 测量 OLV 期间非通气肺中的环境空气吸收（V）和支气管内压力（P）。
接受 VATS 和 OLV 肺切除术的患者被随机分配，使用 DL-ETT 或 BB 测量非通气肺中的 V 或 P。
39 例患者纳入分析。DL-ETT 和 BB 组的平均（均数的标准误[SEM]）V 相似[分别为 504（85）和 630（86）mL；平均差值，126；95%置信区间[CI]，-128 至 380；P=0.31]。在 DL-ETT 和 BB 组中，非通气肺的平均（SEM）P 逐渐变为负值，在胸膜打开时分别达到[-20（5）和-31（10）cmH2O；平均差值，-11；95%CI，-34 至 12；P=0.44]。
在胸膜打开前的 OLV 期间，当肺隔离装置的管腔保持开放时，环境空气会被吸入非通气肺。在胸膜打开前阻塞隔离装置的管腔可以防止这种现象，导致非通气肺中的负压逐渐增加。需要进一步的临床研究来证实这些生理结果及其对肺萎陷和手术结果的影响。
www.clinicaltrials.gov（NCT02919267）；注册于 2016 年 9 月 28 日。
