Nicola Langiano1, Silvia Fiorelli2, Cristian Deana1, Antonio Baroselli1, Elena Giovanna Bignami3, Carola Matellon1, Livia Pompei4, Anna Tornaghi5, Federico Piccioni6, Remo Orsetti7, Cecilia Coccia8, Noemi Sacchi9, Rocco D'Andrea10, Luca Brazzi11, Carlo Franco11, Rosanna Accardo12, Antonio Di Fuccia13, Francesco Baldinelli14, Pasquale De Negri15, Angelo Gratarola16, Chiara Angeletti17, Francesco Pugliese18, Marco Valerio Micozzi2, Domenico Massullo2, Giorgio Della Rocca1. 1. Department of Anesthesia and Intensive Care, University of Udine, Academic Hospital "S. M. della Misericordia", Udine, Italy. 2. Department of Anesthesiology and Intensive care, Sapienza University of Rome, Rome, Italy. 3. Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy. 4. UOC Anesthesia and ICM 1. Azienda Ospedaliera San Camillo Forlanini, Rome, Italy. 5. Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy. 6. Department of Anesthesia, Intensive Care and Palliative Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. 7. Anesthesia and ICM DPT of Pulmonary Diseases, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy. 8. IRCCS IFO Istituto Tumori Regina Elena, Rome, Italy. 9. School of Anesthesia and Intensive Care, University of Milan, Milan, Italy. 10. U.O. Anesthesia and ICM. A.U.O. Policlinico Sant'Orsola Malpighi, Bologna, Italy. 11. AOU "Città della Salute e della Scienza" di Turin, University of Turin, Turin, Italy. 12. Division of Anesthesia, Department of Anesthesia, Endoscopy and Cardiology, Istituto Nazionale Tumori "Fondazione G. Pascale"-IRCCS, Naples, Italy. 13. UOC Anesthesia and Postoperative ICM, Cardarelli Hospital, Naples, Italy. 14. Regional Hospital of Bozen, Bozen, Italy. 15. Department of Anesthesia, Intensive Care and Pain Medicine. IRCCS Centro di Riferimento Oncologico della Basilicata/OECI Clinical Cancer Center - Rionero in Vulture, Potenza, Italy. 16. IRCCS Hospital San Martino-IST, Genoa, Italy. 17. Operative Unit of Anesthesiology, Intensive Care and Pain Medicine, Civil Hospital G. Mazzini of Teramo, Teramo, Italy. Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy. 18. UOD Anesthesia and ICM of Organ Transplantation, DPT Paride Stefanini, Sapienza University of Rome, Rome, Italy.
Abstract
BACKGROUND: One-lung ventilation (OLV) in thoracic anesthesia is required to provide good surgical exposure. OLV is commonly achieved through a double lumen tube (DLT) or a bronchial blocker (BB). Malposition is a relevant issue related to these devices use. No prospective studies with adequately large sample size have been performed to evaluate the malposition rate of DLTs and BBs. METHODS: A total of 2,127 patients requiring OLV during thoracic surgery were enrolled. The aim of this multicenter prospective observational study performed across 26 academic and community hospitals is to evaluate intraoperative malposition rate of DLTs and BBs. We also aim to assess: which device is the most used to achieve OLV, the frequency of bronchoscope (BRO) use, the incidence rate of desaturation during OLV and the role of other factors that can correlate to this event, and incidence of difficult airway. RESULTS: Malposition rate for DLTs was 14%, for BBs 33%. DLTs were used in 95% of patients and BBs in 5%. Mean positioning time was shorter for DLT than BB (156±230 vs. 321±290 s). BRO was used in 54% of patients to check the correct positioning of the DLT. Desaturation occurred in 20% of all cases during OLV achieved through a DLT. Predicting factors of desaturation were dislocation (OR 2.03) and big size of DLT (OR 1.15). BRO use (OR 0.69) and left surgical side (OR 0.41) proved to be protective factors. Difficult airway prevalence was 16%; 10.8% predicted and 5.2% unpredicted. CONCLUSIONS: DLT has a low malpositioning rate and is the preferred device to achieve OLV. BRO use recorded was unexpectedly low. The possibility of encountering a difficult airway is frequent, with an overall prevalence of 16%. Risk factors of desaturation are malposition and increased size of DLT. Left procedures and BRO use could lead to fewer episodes of desaturation.
BACKGROUND: One-lung ventilation (OLV) in thoracic anesthesia is required to provide good surgical exposure. OLV is commonly achieved through a double lumen tube (DLT) or a bronchial blocker (BB). Malposition is a relevant issue related to these devices use. No prospective studies with adequately large sample size have been performed to evaluate the malposition rate of DLTs and BBs. METHODS: A total of 2,127 patients requiring OLV during thoracic surgery were enrolled. The aim of this multicenter prospective observational study performed across 26 academic and community hospitals is to evaluate intraoperative malposition rate of DLTs and BBs. We also aim to assess: which device is the most used to achieve OLV, the frequency of bronchoscope (BRO) use, the incidence rate of desaturation during OLV and the role of other factors that can correlate to this event, and incidence of difficult airway. RESULTS: Malposition rate for DLTs was 14%, for BBs 33%. DLTs were used in 95% of patients and BBs in 5%. Mean positioning time was shorter for DLT than BB (156±230 vs. 321±290 s). BRO was used in 54% of patients to check the correct positioning of the DLT. Desaturation occurred in 20% of all cases during OLV achieved through a DLT. Predicting factors of desaturation were dislocation (OR 2.03) and big size of DLT (OR 1.15). BRO use (OR 0.69) and left surgical side (OR 0.41) proved to be protective factors. Difficult airway prevalence was 16%; 10.8% predicted and 5.2% unpredicted. CONCLUSIONS: DLT has a low malpositioning rate and is the preferred device to achieve OLV. BRO use recorded was unexpectedly low. The possibility of encountering a difficult airway is frequent, with an overall prevalence of 16%. Risk factors of desaturation are malposition and increased size of DLT. Left procedures and BRO use could lead to fewer episodes of desaturation.
Authors: Christopher M Burkle; Michael T Walsh; Barry A Harrison; Timothy B Curry; Steven H Rose Journal: Can J Anaesth Date: 2005 Jun-Jul Impact factor: 5.063
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