Yao Wenlong, Li Meihong, Zhang Chuanhan, Luo Ailin
Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Front Med (Lausanne). 2022 Jun 13;9:822646. doi: 10.3389/fmed.2022.822646. eCollection 2022.
Since their advent, videolaryngoscopes have played an important role in various types of airway management. Lung isolation techniques are often required for thoracic surgery to achieve one-lung ventilation with a double-lumen tube (DLT) or bronchial blocker (BB). In the case of difficult airways, one-lung ventilation is extremely challenging. The purpose of this review is to identify the roles of videolaryngoscopes in thoracic airway management, including normal and difficult airways. Extensive literature related to videolaryngoscopy and one-lung ventilation was analyzed. We summarized videolaryngoscope-guided DLT intubation techniques and discussed the roles of videolaryngoscopy in DLT intubation in normal airways by comparison with direct laryngoscopy. The different types of videolaryngoscopes for DLT intubation are also compared. In addition, we highlighted several strategies to achieve one-lung ventilation in difficult airways using videolaryngoscopes. A non-channeled or channeled videolaryngoscope is suitable for DLT intubation. It can improve glottis exposure and increase the success rate at the first attempt, but it has no advantage in saving intubation time and increases the incidence of DLT mispositioning. Thus, it is not considered as the first choice for patients with anticipated normal airways. Current evidence did not indicate the superiority of any videolaryngoscope to another for DLT intubation. The choice of videolaryngoscope is based on individual experience, preference, and availability. For patients with difficult airways, videolaryngoscope-guided DLT intubation is a primary and effective method. In case of failure, videolaryngoscope-guided single-lumen tube (SLT) intubation can often be achieved or combined with the aid of fibreoptic bronchoscopy. Placement of a DLT over an airway exchange catheter, inserting a BB an SLT, or capnothorax can be selected for lung isolation.
自问世以来，视频喉镜在各类气道管理中发挥了重要作用。胸外科手术常需采用肺隔离技术，通过双腔气管导管（DLT）或支气管封堵器（BB）实现单肺通气。在困难气道的情况下，单肺通气极具挑战性。本综述的目的是确定视频喉镜在胸段气道管理中的作用，包括正常气道和困难气道。分析了与视频喉镜检查和单肺通气相关的大量文献。我们总结了视频喉镜引导下的DLT插管技术，并通过与直接喉镜检查对比，讨论了视频喉镜在正常气道DLT插管中的作用。还比较了用于DLT插管的不同类型视频喉镜。此外，我们强调了几种使用视频喉镜在困难气道中实现单肺通气的策略。非通道型或通道型视频喉镜适用于DLT插管。它可改善声门暴露并提高首次尝试成功率，但在节省插管时间方面并无优势，且会增加DLT误置的发生率。因此，对于预期气道正常的患者，它不被视为首选。目前的证据并未表明在DLT插管方面，任何一种视频喉镜优于另一种。视频喉镜的选择基于个人经验、偏好和可用性。对于困难气道患者，视频喉镜引导下的DLT插管是一种主要且有效的方法。若插管失败，视频喉镜引导下单腔气管导管（SLT）插管通常可以完成，或借助纤维支气管镜辅助完成。可选择在气道交换导管上放置DLT、插入BB或SLT，或采用二氧化碳胸廓造口术进行肺隔离。
