一种用于单肺通气的支气管封堵器盲插新技术：一项前瞻性、随机、交叉研究。
A novel technique of blindly positioning bronchial blockers for one-lung ventilation: a prospective, randomized, crossover study.
作者信息
Min Seihee, Yoon Susie, Han Jiwon, Seo Jeong-Hwa, Bahk Jae-Hyon
机构信息
Department of Anesthesiology and Pain Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, 110 Deokan-ro, Gwangmyeong-si, Gyeonggi-do, 14353, Republic of Korea.
Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
出版信息
J Cardiothorac Surg. 2025 Jan 9;20(1):50. doi: 10.1186/s13019-024-03276-8.
BACKGROUND
Several methods for blindly positioning bronchial blockers (BBs) for one-lung ventilation (OLV) have been proposed. However, these methods do not reliably ensure accurate positioning and proper direction. Here, we developed a clinically applicable two-stage maneuver by modifying a previously reported one-stage maneuver for successful insertion of a BB at the appropriate depth and direction in patients requiring lung isolation where a flexible bronchoscope (FOB) is not applicable.
METHODS
This prospective, randomized, crossover study was conducted at a tertiary university hospital and included 94 patients requiring OLV for elective thoracic surgery under general anesthesia. The patients underwent the one-stage maneuver followed by the two-stage maneuver and vice versa, and the success rates of the two methods were compared. After tracheal intubation, the deflated rigid-angle BB was inserted into the endotracheal tube (ET) until a pre-marked point indicating that the BB was just protruding from the ET tip. To identify the carinal depth without FOB, the BB balloon was inflated and advanced toward the intended side whilst monitoring abrupt changes in peak inspiratory pressure and expiratory tidal volume to indicate placement at the carina. In one-stage maneuver, the BB balloon was deflated and advanced 3 cm further from the estimated carinal depth. During the two-stage maneuver, the same procedure was performed to determine the carinal depth, and the deflated BB was withdrawn and reinserted to a predetermined depth with its tip directed 90 degree toward the target bronchus. The accuracy of BB positioning for both maneuvers was evaluated by a 4-point scale, with grades 1 and 2 considered acceptable for providing OLV.
RESULTS
BB placement was more accurate in the two-stage maneuver than in the one-stage maneuver [88.0% (81/92) vs. 73.9% (68/92), relative risk (95% confidence interval [CI]), 0.45 (0.23-0.88), P < 0.001]. This improvement was particularly significant when targeting the left main bronchus [84.8% (39/46) vs. 58.7% (27/46), relative risk (95% CI), 0.36 (0.17-0.79), P < 0.001)].
CONCLUSIONS
The novel two-stage maneuver significantly improved the success rate of blindly positioning the BB.
TRIAL REGISTRATION
This study was registered in ClinicalTrials.gov (NCT02981537) on December 05, 2016.
背景
已经提出了几种在单肺通气（OLV）时盲目放置支气管封堵器（BB）的方法。然而，这些方法不能可靠地确保准确放置和正确方向。在此，我们通过修改先前报道的单步操作，开发了一种临床适用的两步操作，以便在无法使用可弯曲支气管镜（FOB）的需要肺隔离的患者中，以适当的深度和方向成功插入BB。
方法
这项前瞻性、随机、交叉研究在一家三级大学医院进行，纳入了94例在全身麻醉下进行择期胸外科手术需要OLV的患者。患者先接受单步操作，然后接受两步操作，反之亦然，并比较两种方法的成功率。气管插管后，将放气的硬角BB插入气管内导管（ET），直到一个预先标记的点，表明BB刚从ET尖端突出。为了在不使用FOB的情况下确定隆突深度，在监测吸气峰压和呼气潮气量的突然变化以指示放置在隆突处时，将BB球囊充气并向预期侧推进。在单步操作中，将BB球囊放气，并从估计的隆突深度再向前推进3 cm。在两步操作中，执行相同的程序以确定隆突深度，将放气的BB拔出并重新插入到预定深度，其尖端指向目标支气管90度。两种操作中BB放置的准确性通过4分制进行评估，1级和2级被认为可接受以提供OLV。
结果
两步操作中BB的放置比单步操作更准确[88.0%（81/92）对73.9%（68/92），相对风险（95%置信区间[CI]），0.45（0.23 - 0.88），P < 0.001]。当以左主支气管为目标时，这种改善尤为显著[84.8%（39/46）对58.7%（27/46），相对风险（95% CI），0.36（0.17 - 0.79），P < 0.001]。
结论
新的两步操作显著提高了BB盲目放置的成功率。
试验注册
本研究于2016年12月5日在ClinicalTrials.gov（NCT02981537）注册。
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