Department of Thoracic Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
Department of Anesthesiology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
Eur J Cardiothorac Surg. 2023 May 2;63(5). doi: 10.1093/ejcts/ezad158.
Double-lumen endobronchial tubes (DLTs) are essential for differential lung ventilation during pulmonary lobectomy, but they are more rigid, longer, larger in diameter and irritable. Coughing at extubation sometimes causes airway and lung injury, which causes severe air leaks, prolonged cough and sore throat. We examined the prevalence of cough-associated air leaks at extubation and postoperative cough or sore throat after lobectomy and evaluated the efficacy of supraglottic airway (SGA) in preventing these complications.
Patient characteristics and operative and postoperative factors data were collected from patients who underwent pulmonary lobectomy between January 2013 and March 2022. After propensity score matching, these data were compared between the SGA and DLT groups.
A total of 1069 patients with lung cancer (SGA, 641; DLTs, 428) were enrolled and coughing at extubation occurred in 100 (23.4%) patients in the DLT group, 65 (65.0%) showed increased cough-associated air leaks at extubation and 20 (30.8%) showed prolonged air leaks. Coughing at extubation occurred in 6 (0.9%) in the SGA group. In 193 patients from each group after propensity score matching, coughing at extubation and the associated air leak increase were significantly lower in the SGA group. Visual analogue scale of postoperative cough and sore throat on postoperative days 2, 7 and 30 were significantly lower in the SGA group.
SGA is effective and safe for preventing cough-associated air leaks and prolonged postoperative cough or sore throat at extubation following pulmonary lobectomy.
双腔支气管导管（DLTs）对于肺叶切除术中的肺隔离通气至关重要，但它们更硬、更长、直径更大且易刺激。拔管时咳嗽有时会导致气道和肺部损伤，引起严重的空气泄漏、长时间咳嗽和喉咙痛。我们检查了肺叶切除术后拔管时与咳嗽相关的空气泄漏以及术后咳嗽或喉咙痛的发生率，并评估了声门上气道（SGA）预防这些并发症的效果。
收集 2013 年 1 月至 2022 年 3 月期间接受肺叶切除术的患者的患者特征和手术及术后因素数据。在进行倾向评分匹配后，比较 SGA 和 DLT 组之间的数据。
共纳入 1069 例肺癌患者（SGA 组 641 例，DLTs 组 428 例），在 DLT 组中，100 例（23.4%）患者在拔管时咳嗽，65 例（65.0%）在拔管时出现咳嗽相关空气泄漏增加，20 例（30.8%）出现空气泄漏延长。SGA 组有 6 例（0.9%）患者在拔管时咳嗽。在每组 193 例经倾向评分匹配后，SGA 组拔管时咳嗽和相关空气泄漏增加明显更低。SGA 组术后第 2、7 和 30 天的术后咳嗽和喉咙痛的视觉模拟量表评分明显更低。
SGA 可有效预防肺叶切除术后拔管时与咳嗽相关的空气泄漏以及术后咳嗽或喉咙痛的延长。
