Rosboch Giulio Luca, Lyberis Paraskevas, Ceraolo Edoardo, Balzani Eleonora, Cedrone Martina, Piccioni Federico, Ruffini Enrico, Brazzi Luca, Guerrera Francesco
Department of Anesthesia, Intensive Care and Emergency, "Città della Salute e della Scienza di Torino" Hospital, Torino, Italy.
Department of Cardiovascular and Thoracic Surgery, "Città della Salute e della Scienza di Torino" Hospital, Torino, Italy.
Front Surg. 2022 Apr 4;9:868287. doi: 10.3389/fsurg.2022.868287. eCollection 2022.
Non-intubated thoracic surgery (NITS) is a growing practice, alongside minimally invasive thoracic surgery. To date, only a consensus of experts provided opinions on NITS leaving a number of questions unresolved. We then conducted a scoping review to clarify the state of the art regarding NITS. The systematic review of all randomized and non-randomized clinical trials dealing with NITS, based on Pubmed, EMBASE, and Scopus, retrieved 665 articles. After the exclusion of ineligible studies, 53 were assessed examining: study type, Country of origin, surgical procedure, age, body mass index, American Society of Anesthesiologist's physical status, airway management device, conversion to orotracheal intubation and pulmonary complications rates and length of hospital stay. It emerged that NITS is a procedure performed predominantly in Asia, and certain European Countries. In China, NITS is more frequently performed for parenchymal resection surgery, whereas in Europe, it is mainly employed for pleural pathologies. The most commonly used device for airway management is the laryngeal mask. The conversion rate to orotracheal intubation is a~3%. The results of the scoping review seem to suggest that NITS procedures are becoming increasingly popular, but its role needs to be better defined. Further randomized clinical trials are needed to better define the role of the clinical variables possibly impacting on the technique effectiveness.
https://osf.io/mfvp3/, identifier: 10.17605/OSF.IO/MFVP3.
非气管插管胸外科手术（NITS）与微创胸外科手术一样，应用越来越广泛。迄今为止，仅有专家共识对NITS发表了意见，仍有一些问题未得到解决。为此，我们进行了一项范围综述，以阐明NITS的现有技术水平。基于PubMed、EMBASE和Scopus对所有涉及NITS的随机和非随机临床试验进行系统综述，共检索到665篇文章。排除不合格研究后，对53项研究进行了评估，内容包括：研究类型、原产国、手术方式、年龄、体重指数、美国麻醉医师协会身体状况、气道管理设备、转为经口气管插管的情况以及肺部并发症发生率和住院时间。结果显示，NITS主要在亚洲和某些欧洲国家开展。在中国，NITS更常用于实质性切除手术，而在欧洲，主要用于胸膜疾病。最常用的气道管理设备是喉罩。转为经口气管插管的比例约为3%。范围综述的结果似乎表明，NITS手术越来越受欢迎，但其作用仍需更好地界定。需要进一步开展随机临床试验，以更好地明确可能影响该技术有效性的临床变量的作用。
