Department of Anaesthesiology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China.
Department of Anaesthesiology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
BMJ Open. 2023 Apr 5;13(4):e068071. doi: 10.1136/bmjopen-2022-068071.
A double-lumen tube (DLT) is a traditional one-lung ventilation tool that needs to be positioned under the guidance of a fibreoptic bronchoscope or auscultation. The placement is complex, and poor positioning often causes hypoxaemia. In recent years, VivaSight double-lumen tubes (v-DLTs) have been widely used in thoracic surgery. Because the tubes can be continuously observed during intubation and the operation, malposition can be corrected at any time. However, the effect of v-DLT on perioperative hypoxaemia has been rarely reported. The aim of this study was to observe the incidence of hypoxaemia during one-lung ventilation with v-DLT and to compare the perioperative complications between v-DLT and conventional double-lumen tube (c-DLT).
One hundred patients planning to undergo thoracoscopic surgery will be randomised into the c-DLT group and the v-DLT group. During one-lung ventilation, both groups of patients will receive low tidal volume for volume control ventilation. When the blood oxygen saturation falls below 95%, the DLT will be repositioned and the oxygen concentration will be increased to improve the respiratory parameters (5 cm HO Positive end-expiratory pressure (PEEP) on the ventilation side and 5 cm HO CPAP (continuous airway positive pressure) on the operation side), and double lung ventilation measures will be taken in sequence to prevent a further decline in blood oxygen saturation. The primary outcomes are the incidence and duration of hypoxaemia and the number of intraoperative hypoxaemia treatments, and the secondary outcomes will be postoperative complications and total hospitalisation expenses.
The study protocol was approved by the Clinical Research Ethics Committee of The First Affiliated Hospital, Sun Yat-sen University (2020-418) and registered at the Chinese Clinical Trial Registry (http://www.chictr.org.cn). The results of the study will be analysed and reported.
ChiCTR2100046484.
双腔管(DLT)是一种传统的单肺通气工具,需要在纤维支气管镜或听诊引导下定位。这种定位比较复杂,且定位不良常导致低氧血症。近年来,可视双腔管(v-DLT)在胸外科中得到了广泛应用。由于在插管和手术过程中可以对其进行持续观察,因此可以随时纠正错位。但是,v-DLT 对围手术期低氧血症的影响很少有报道。本研究旨在观察 v-DLT 单肺通气时低氧血症的发生率,并比较 v-DLT 和传统双腔管(c-DLT)的围手术期并发症。
将计划接受胸腔镜手术的 100 例患者随机分为 c-DLT 组和 v-DLT 组。两组患者在单肺通气期间均接受小潮气量容量控制通气。当血氧饱和度下降至 95%以下时,重新定位 DLT,并增加氧浓度以改善呼吸参数(通气侧 5cmH2O 呼气末正压(PEEP)和手术侧 5cmH2O CPAP(持续气道正压)),然后依次采取双肺通气措施,防止血氧饱和度进一步下降。主要结局是低氧血症的发生率和持续时间以及术中低氧血症治疗的次数,次要结局是术后并发症和总住院费用。
该研究方案经中山大学附属第一医院临床研究伦理委员会批准(2020-418),并在中国临床试验注册中心(http://www.chictr.org.cn)注册。将对研究结果进行分析和报告。
ChiCTR2100046484。