Vannucci Jacopo, Capozzi Rosanna, Vinci Damiano, Ceccarelli Silvia, Potenza Rossella, Scarnecchia Elisa, Spinosa Emilio, Romito Mara, Napolitano Antonio Giulio, Puma Francesco
Department of Thoracic Surgery and Lung Transplantation, University of Rome Sapienza, Policlinico Umberto I, 00161 Rome, Italy.
Department of Thoracic Surgery, University of Perugia Medical School, Ospedale Santa Maria della Misericordia, 06134 Perugia, Italy.
J Clin Med. 2023 Aug 12;12(16):5258. doi: 10.3390/jcm12165258.
Our aim was to report on the use of an innovative technique for airway management utilizing a small diameter, short-cuffed, long orotracheal tube for assisting operative rigid bronchoscopy in critical airway obstruction.
We retrospectively reviewed the clinical data of 36 patients with life-threatening critical airway stenosis submitted for rigid bronchoscopy between January 2008 and July 2021. The supporting ventilatory tube, part of the Translaryngeal Tracheostomy KIT (Fantoni method), was utilized in tandem with the rigid bronchoscope during endoscopic airway reopening.
Indications for collateral intubation were either tumors of the trachea with near-total airway obstruction (13), or tumors of the main carina with total obstruction of one main bronchus and possible contralateral involvement (23). Preliminary dilation was necessary before tube placement in only 2/13 patients with tracheal-obstructing tumors (15.4%). No postoperative complications were reported. There was one case of an intraoperative cuff tear, with no further technical problems.
In our experience, this innovative method proved to be safe, allowing for continuous airway control. It enabled anesthesia inhalation, use of neuromuscular blockage and reliable end-tidal CO monitoring, along with protection of the distal airway from blood flooding. The shorter time of the procedure was due to the lack of need for pauses to ventilate the patient.
我们的目的是报告一种创新的气道管理技术的应用，该技术使用小直径、短套囊、长的口气管导管来辅助在严重气道阻塞情况下进行的硬质支气管镜手术。
我们回顾性分析了2008年1月至2021年7月期间36例因危及生命的严重气道狭窄而接受硬质支气管镜检查的患者的临床资料。在进行内镜气道再通时，将经喉气管切开套件（Fantoni法）的支撑通气导管与硬质支气管镜串联使用。
并行插管的适应证为气管肿瘤伴几乎完全气道阻塞（13例），或主隆突肿瘤伴一个主支气管完全阻塞且可能累及对侧（23例）。在仅2/13例气管阻塞性肿瘤患者（15.4%）中，插管前需要进行预扩张。未报告术后并发症。有1例术中套囊撕裂，未出现进一步的技术问题。
根据我们的经验，这种创新方法被证明是安全的，可实现持续气道控制。它能够进行麻醉吸入、使用神经肌肉阻滞并可靠地监测呼气末二氧化碳，同时保护远端气道免受血液灌注。手术时间较短是因为无需暂停对患者进行通气。
