Comparison of efficacy and safety of different suction pressure for speeding non-ventilated lung collapse in uniport video-assisted thoracoscopic surgery: a randomized-controlled trial.

BACKGROUND

The bronchial suction has been applied in speeding lung collapse. Low suction pressure may not speed lung collapse, but high pressure causes occult lung injury. The aim of the study was to explore efficacy and safety of different suction pressure for speeding lung collapse.

METHODS

Eighty-four subjects undergoing uniport video-assisted thoracoscopic surgery (VATS) were randomly assigned for non-suction (Group 0), -10 cmHO suction pressure (Group - 10), and - 30 cmHO suction pressure (Group - 30). The primary outcome were the lung collapse scores (LCS) at 0 min (T) after the visualization of the lung using a 10-point visual analogue scale and area under the curve (AUC) of LCS over time. The secondary outcomes included disconnection from the ventilator, the assessment of occult lung injury using NOS-3 expression, histologic scores of lung injury, and lung W/D weight ratio, intraoperative hypoxemia, the incidence of perioperative pulmonary complications.

RESULTS

Both the LCS at T and AUC analysis showed that compared with Group 0, Group - 10 and Group - 30 significantly achieved good lung collapse (P < 0.05), but no difference between Group - 10 and Group - 30. Four patients in Group 0 were treated with disconnection maneuver. The assessment of occult lung injury showed no differences.

CONCLUSIONS

Applying - 10 cmHO suction pressure for 1 min when pleural incision is a relatively safe method to promote lung collapse without the occurrence of occult lung injury.

TRIAL REGISTRATION

Chinese Clinical Trial Registry number, ChiCTR2200062991. Registered on 26/08/2022.