Xiang Quan1, Jie Yi1, Yuguang Huang1, Xiuhua Zhang1, Le Shen1, Shanqing Li2. 1. Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China. 2. Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
Abstract
BACKGROUND: Bronchial suction through the lumen of a bronchial blocker has been reported to accelerate lung collapse. The aim of the current study was to examine whether bronchial suction could also facilitate lung collapse when using a double-lumen tube (DLT). METHODS: Eighty patients scheduled for elective video-assisted thoracoscopic surgery for lung cancer using a DLT for one-lung ventilation (OLV) were randomised into an arm that received bronchial suction and an arm that underwent spontaneous collapse (n=40 per arm). For bronchial suction, a pressure of -30 cmH2O was applied to the lumen of the non-ventilated lung during the first minute of OLV. The primary endpoint was the degree of lung collapse at 10 min after the start of OLV, assessed on a 10-point visual analogue scale (0: fully inflated; 10: complete collapse). Secondary outcomes included lung collapse at 1 and 5 min after the start of OLV, as well as occurrence of intraoperative hypoxemia. RESULTS: Median (interquartile range) lung collapse scores at 10 min were statistically greater in the bronchial suction arm than in the spontaneous collapse arm [9.0 (9.0-9.0) vs. 8.5 (8.0-9.0); P=0.004]. Lung collapse was also statistically greater in the bronchial suction arm at 5 min [8.0 (7.0-8.0) vs. 7.0 (6.25-7.0) min; P=0.002] and 1 min [4.0 (4.0-5.0) vs. 2.0 (2.0-2.0) min; P<0.001]. None of the patients experienced intraoperative hypoxemia and operative complications. CONCLUSIONS: Bronchial suction resulted in statistically greater but not clinically meaningful lung collapse when using a DLT. However, greater degree of lung collapse at 1-min could be helpful in reducing accidental injuries.
BACKGROUND: Bronchial suction through the lumen of a bronchial blocker has been reported to accelerate lung collapse. The aim of the current study was to examine whether bronchial suction could also facilitate lung collapse when using a double-lumen tube (DLT). METHODS: Eighty patients scheduled for elective video-assisted thoracoscopic surgery for lung cancer using a DLT for one-lung ventilation (OLV) were randomised into an arm that received bronchial suction and an arm that underwent spontaneous collapse (n=40 per arm). For bronchial suction, a pressure of -30 cmH2O was applied to the lumen of the non-ventilated lung during the first minute of OLV. The primary endpoint was the degree of lung collapse at 10 min after the start of OLV, assessed on a 10-point visual analogue scale (0: fully inflated; 10: complete collapse). Secondary outcomes included lung collapse at 1 and 5 min after the start of OLV, as well as occurrence of intraoperative hypoxemia. RESULTS: Median (interquartile range) lung collapse scores at 10 min were statistically greater in the bronchial suction arm than in the spontaneous collapse arm [9.0 (9.0-9.0) vs. 8.5 (8.0-9.0); P=0.004]. Lung collapse was also statistically greater in the bronchial suction arm at 5 min [8.0 (7.0-8.0) vs. 7.0 (6.25-7.0) min; P=0.002] and 1 min [4.0 (4.0-5.0) vs. 2.0 (2.0-2.0) min; P<0.001]. None of the patients experienced intraoperative hypoxemia and operative complications. CONCLUSIONS: Bronchial suction resulted in statistically greater but not clinically meaningful lung collapse when using a DLT. However, greater degree of lung collapse at 1-min could be helpful in reducing accidental injuries.
Authors: Manu Narayanaswamy; Karen McRae; Peter Slinger; Geoffrey Dugas; George W Kanellakos; Andy Roscoe; Melanie Lacroix Journal: Anesth Analg Date: 2009-04 Impact factor: 5.108