Journal of cardiothoracic and vascular anesthesia · 2020
The Incidence of Tracheal Bronchus in Thoracic Surgery Patients and Its Implication for Lung Isolation: A Retrospective Cohort Study.
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Cheng Lili, Liu Shiqing, Qi Wenxu, Dong Youjing
Аннотация
OBJECTIVE: To investigate the incidence of tracheal bronchus (TB) and explore its implication for lung isolation.
DESIGN: Retrospective cohort study.
SETTING: Academic, tertiary care hospital.
PARTICIPANTS: The study comprised 7,102 thoracic patients with- one lung ventilation.
INTERVENTIONS: No intervention.
MEASUREMENTS AND MAIN RESULTS: Two independent anesthesiologists reviewed the computed tomography images to identify the presence of a TB, and their results were confirmed by a radiologist. The clinical data of patients with a TB were obtained from the electronic medical record. Data regarding the device used to provide lung isolation, preoperative oxygen saturation (SpO2), and intraoperative SpO2 during one- lung ventilation were obtained from the electronic anesthesia record. The incidence of TB was 1.08% (77 of 7,102). The TB arose from the right side of the trachea in all 77 patients, including 70 type Ⅲ TBs and 7 type Ⅱ TBs. Left- and right-sided double-lumen tubes (DLTs) were used in 54 and 23 patients, respectively. For patients with a left-sided DLT, the median SpO2 and incidence of hypoxemia (SpO2 <90%) were 97% and 6 of 54 (11.1%), respectively. For patients with a right DLT, the median SpO2 and incidence of hypoxemia were 95% and 7 of 20 (35.0%), respectively. There were significant differences in the mean SpO2 and the incidence of hypoxemia between patients intubated with left- and right-sided DLTs (p = 0.014 and p = 0.016, respectively).
CONCLUSIONS: Preoperative diagnosis of TB is important when lung isolation is needed. The left-sided DLT can be used for most patients with a TB.
DESIGN: Retrospective cohort study.
SETTING: Academic, tertiary care hospital.
PARTICIPANTS: The study comprised 7,102 thoracic patients with- one lung ventilation.
INTERVENTIONS: No intervention.
MEASUREMENTS AND MAIN RESULTS: Two independent anesthesiologists reviewed the computed tomography images to identify the presence of a TB, and their results were confirmed by a radiologist. The clinical data of patients with a TB were obtained from the electronic medical record. Data regarding the device used to provide lung isolation, preoperative oxygen saturation (SpO2), and intraoperative SpO2 during one- lung ventilation were obtained from the electronic anesthesia record. The incidence of TB was 1.08% (77 of 7,102). The TB arose from the right side of the trachea in all 77 patients, including 70 type Ⅲ TBs and 7 type Ⅱ TBs. Left- and right-sided double-lumen tubes (DLTs) were used in 54 and 23 patients, respectively. For patients with a left-sided DLT, the median SpO2 and incidence of hypoxemia (SpO2 <90%) were 97% and 6 of 54 (11.1%), respectively. For patients with a right DLT, the median SpO2 and incidence of hypoxemia were 95% and 7 of 20 (35.0%), respectively. There were significant differences in the mean SpO2 and the incidence of hypoxemia between patients intubated with left- and right-sided DLTs (p = 0.014 and p = 0.016, respectively).
CONCLUSIONS: Preoperative diagnosis of TB is important when lung isolation is needed. The left-sided DLT can be used for most patients with a TB.