Jacques Somma1, Étienne J Couture1, Sabrina Pelletier2, Steeve Provencher3, Olivier Moreault2, Jens Lohser4, Paula A Ugalde3, Louise Vigneault1, Jérome Lemieux1, Antoine Somma5, Sarah-Elizabeth Guay6, Jean S Bussières7. 1. Department of Anesthesiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval, 2725, Chemin Sainte-Foy, Quebec City, QC, G1V 4G5, Canada. 2. Department of Anesthesiology and Critical Care, Laval University, Quebec City, QC, Canada. 3. Department of Respirology and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval, Quebec City, QC, Canada. 4. Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver General Hospital, Vancouver, BC, Canada. 5. Faculté des sciences et génie, Departement d'informatique et de génie logiciel, Laval University, Quebec City, QC, Canada. 6. Laval University, Quebec City, QC, Canada. 7. Department of Anesthesiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval, 2725, Chemin Sainte-Foy, Quebec City, QC, G1V 4G5, Canada. jbuss@criucpq.ulaval.ca.
Abstract
PURPOSE:Lung deflation during one-lung ventilation (OLV) is thought to be faster using a double-lumen endotracheal tube (DL-ETT) than with a bronchial blocker, especially when the non-ventilated lumen is opened to allow egress of air from the operative lung. Nevertheless, ambient air can also be entrained into the non-ventilated lumen before pleural opening and subsequently delay deflation. We therefore hypothesized that occluding the non-ventilated DL-ETT lumen during OLV before pleural opening would prevent air entrainment and consequently enhance operative lung deflation during video-assisted thoracoscopic surgery (VATS). METHODS:Thirty patients undergoing VATS using DL-ETT to allow OLV were randomized to having the lumen of the operative lung either open (control group) or occluded (intervention group) to ambient air. The primary outcome was the time to lung collapse evaluated intraoperatively by the surgeons. The T50, an index of rate of deflation, was also determined from a probabilistic model derived from intraoperative video clips presented in random order to three observers. RESULTS: The median [interquartile range] time to lung deflation occurred faster in the intervention group than in the control group (24 [20-37] min vs 54 [48-68] min, respectively; median difference, 30 min; 95% confidence interval [CI], 14 to 46; P < 0.001). The estimated T50 was 32.6 min in the intervention group compared with 62.3 min in the control group (difference, - 29.7 min; 95% CI, - 51.1 to - 8.4; P = 0.008). CONCLUSION:Operative lung deflation during OLV with a DL-ETT is faster when the operative lumen remains closed before pleural opening thus preventing it from entraining ambient air during the closed chest phase of OLV. TRIAL REGISTRATION: www.clinicaltrials.gov (NCT03508050); registered 27 September 2017.
RCT Entities:
PURPOSE: Lung deflation during one-lung ventilation (OLV) is thought to be faster using a double-lumen endotracheal tube (DL-ETT) than with a bronchial blocker, especially when the non-ventilated lumen is opened to allow egress of air from the operative lung. Nevertheless, ambient air can also be entrained into the non-ventilated lumen before pleural opening and subsequently delay deflation. We therefore hypothesized that occluding the non-ventilated DL-ETT lumen during OLV before pleural opening would prevent air entrainment and consequently enhance operative lung deflation during video-assisted thoracoscopic surgery (VATS). METHODS: Thirty patients undergoing VATS using DL-ETT to allow OLV were randomized to having the lumen of the operative lung either open (control group) or occluded (intervention group) to ambient air. The primary outcome was the time to lung collapse evaluated intraoperatively by the surgeons. The T50, an index of rate of deflation, was also determined from a probabilistic model derived from intraoperative video clips presented in random order to three observers. RESULTS: The median [interquartile range] time to lung deflation occurred faster in the intervention group than in the control group (24 [20-37] min vs 54 [48-68] min, respectively; median difference, 30 min; 95% confidence interval [CI], 14 to 46; P < 0.001). The estimated T50 was 32.6 min in the intervention group compared with 62.3 min in the control group (difference, - 29.7 min; 95% CI, - 51.1 to - 8.4; P = 0.008). CONCLUSION: Operative lung deflation during OLV with a DL-ETT is faster when the operative lumen remains closed before pleural opening thus preventing it from entraining ambient air during the closed chest phase of OLV. TRIAL REGISTRATION: www.clinicaltrials.gov (NCT03508050); registered 27 September 2017.
Authors: Jacques Somma; Étienne J Couture; Sabrina Pelletier; Steeve Provencher; Olivier Moreault; Jens Lohser; Paula A Ugalde; Louise Vigneault; Jérome Lemieux; Antoine Somma; Sarah-Elizabeth Guay; Jean S Bussières Journal: Can J Anaesth Date: 2021-04-02 Impact factor: 5.063
Authors: Shi Yang Li; Wei Yu Yao; Yong Jin Yuan; Wen Shu Tay; Nian-Lin Reena Han; Rehena Sultana; Pryseley N Assam; Alex Tiong-Heng Sia; Ban Leong Sng Journal: BMC Anesthesiol Date: 2017-12-19 Impact factor: 2.217
Authors: Jacques Somma; Étienne J Couture; Sabrina Pelletier; Steeve Provencher; Olivier Moreault; Jens Lohser; Paula A Ugalde; Louise Vigneault; Jérome Lemieux; Antoine Somma; Sarah-Elizabeth Guay; Jean S Bussières Journal: Can J Anaesth Date: 2021-04-02 Impact factor: 5.063