Mohamed R El-Tahan1. 1. From the Department of Anaesthesia and Surgical ICU, King Fahd Hospital of the University of Dammam, Al Khubar, Saudi Arabia and Anaesthesiology Department, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt (MR-ET).
Abstract
BACKGROUND: The use of the Arndt endobronchial blocker has not gained widespread acceptance during video-assisted thoracoscopic surgery (VATS) because of its high cost and longer time to operative lung collapse especially in patients with chronic obstructive pulmonary disease (COPD). The use of a ventilator disconnection technique has been shown to produce a comparable degree of lung collapse when used with either a double-lumen tube or an Arndt endobronchial blocker. OBJECTIVE: We hypothesised that the use of bronchial suction through the suction port of the endobronchial blocker would be associated with a comparable time to achieve optimum lung collapse as the disconnection technique. DESIGN: A randomised, double-blind study. SETTING: Single university hospital. PARTICIPANTS: Fifty-eight patients with spontaneous pneumothorax scheduled for elective VATS using the Arndt endobronchial blocker for one-lung ventilation (OLV). INTERVENTIONS: Patients were randomly assigned to one of two groups (n = 29 per group) to deflate the operative lung with either disconnection of the endotracheal tube from the ventilator for 60 s prior to inflation of the endobronchial blocker or connection of a suction pressure of -30 cmH2O to the suction port of the endobronchial blocker through the barrel of a 1 ml syringe. MAIN OUTCOME MEASURES: The primary outcome was the time to total lung collapse. Secondary outcomes included surgeon rating of lung collapse, overall surgeon satisfaction, need for further fibreoptic bronchial suction manoeuvres and intraoperative hypoxaemia. RESULTS: The bronchial suction technique was associated with a significantly shorter time to total lung collapse than the disconnection method [93 (95% confidence interval, 95% CI 81.3 to 103.7) vs. 197 (95% CI 157.4 to 237) s respectively; P < 0.001]. Both the disconnection and bronchial suction groups had a comparable surgical rating of excellent lung collapse 40 min after the start of OLV (65.5 vs. 79.3%, respectively; P = 0.24), overall surgeon satisfaction [median (interquartile range, IQR) 9 (8 to 10) vs. 9 (8 to 10) respectively; P = 0.90] and intraoperative hypoxaemia (3.5 vs. 0%, respectively; P = 0.32). No patient in the bronchial suction group needed further manoeuvres to collapse the surgical lung. Moreover, the presence of COPD showed a significant positive correlation with the time to total lung collapse (Spearman r = 0.564; P < 0.001). CONCLUSION: The use of continuous bronchial suction through the lumen of the Arndt blocker offers an effective method to accelerate lung collapse. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT02030795.
RCT Entities:
BACKGROUND: The use of the Arndt endobronchial blocker has not gained widespread acceptance during video-assisted thoracoscopic surgery (VATS) because of its high cost and longer time to operative lung collapse especially in patients with chronic obstructive pulmonary disease (COPD). The use of a ventilator disconnection technique has been shown to produce a comparable degree of lung collapse when used with either a double-lumen tube or an Arndt endobronchial blocker. OBJECTIVE: We hypothesised that the use of bronchial suction through the suction port of the endobronchial blocker would be associated with a comparable time to achieve optimum lung collapse as the disconnection technique. DESIGN: A randomised, double-blind study. SETTING: Single university hospital. PARTICIPANTS: Fifty-eight patients with spontaneous pneumothorax scheduled for elective VATS using the Arndt endobronchial blocker for one-lung ventilation (OLV). INTERVENTIONS:Patients were randomly assigned to one of two groups (n = 29 per group) to deflate the operative lung with either disconnection of the endotracheal tube from the ventilator for 60 s prior to inflation of the endobronchial blocker or connection of a suction pressure of -30 cmH2O to the suction port of the endobronchial blocker through the barrel of a 1 ml syringe. MAIN OUTCOME MEASURES: The primary outcome was the time to total lung collapse. Secondary outcomes included surgeon rating of lung collapse, overall surgeon satisfaction, need for further fibreoptic bronchial suction manoeuvres and intraoperative hypoxaemia. RESULTS: The bronchial suction technique was associated with a significantly shorter time to total lung collapse than the disconnection method [93 (95% confidence interval, 95% CI 81.3 to 103.7) vs. 197 (95% CI 157.4 to 237) s respectively; P < 0.001]. Both the disconnection and bronchial suction groups had a comparable surgical rating of excellent lung collapse 40 min after the start of OLV (65.5 vs. 79.3%, respectively; P = 0.24), overall surgeon satisfaction [median (interquartile range, IQR) 9 (8 to 10) vs. 9 (8 to 10) respectively; P = 0.90] and intraoperative hypoxaemia (3.5 vs. 0%, respectively; P = 0.32). No patient in the bronchial suction group needed further manoeuvres to collapse the surgical lung. Moreover, the presence of COPD showed a significant positive correlation with the time to total lung collapse (Spearman r = 0.564; P < 0.001). CONCLUSION: The use of continuous bronchial suction through the lumen of the Arndt blocker offers an effective method to accelerate lung collapse. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT02030795.