Effect Of Bronchial Intubation For Constant-pressure Expanding The Ipsilateral Lung On Postoperatively Intractable Atelectasis In Hypo-analgesia And Muscle Relax

Objective:To investigate the effect of bronchial intubation for expanding the collapsed lung with a constant-pressure on postoperatively intractable atelectasis.Methods:From January 2005 to May 2010,20 patients with atelectasis were recruited in the prospective study, and the collapsed lung could not been re-expanded by bronchoscopic suctioning, closed thoracic drainage, backslap, blowing hall and other routine treatment for more than a week. All patients fasting for 6 hours before the procedure, on arrival in the operation room, patients were monitored with electrocardiography (ECG), noninvasive blood pressure (BP), oxygen saturation via pulse oximetry (SpO2). Patients were preoxygenated with 100% O2 (8L/min). Propofol, atropine and succinylcholine were used for ipsilateral bronchial intubation, and the intubation was guided by fiberoptic bronchoscope. After correct placement of bronchial intubation was confirmed, the ipsilateral lung was inflated in a manual way. The airway plateau pressure was maintained at 30-50 cmH20 for 20 seconds, and the procedure was repeated until the clear breath sound can be heard at the original collapsed lung or the pleural drainage closed drainage bottle were basically no bubbles or liquid overflow drainage. If the spontaneous breathin resumed during the operation, additional propofol lmg/kg and succinylcholine 0.5mg/kg were infused to maintain anesthesia. After procedure, the bronchial tube was drawn back into tracheal, and postoperative tracheal extubation was performed when breathing approached to normal status, as well consciousness is recoved. After extubation, dexamethasone 0.2mg/kg was infused for preventing reexpansion pulmonary edema, then the patients were sent back to ward 30min later. The therapeutic effect was evaluated by chest X-ray examination and auscultation at the following day. If the collapsed lung was not re-expanded, the simil treatment was performed the next day. Consecutive three times treatment ineffective is regard as treatment failure.Results:Under general anesthesia, the constant-pressure expanding of the ipsilateral lung was completed smoothly in 19 patients following fiberoptic bronchoscope guided bronchial intubation. The data of one patient was excluded due to the bronchus was blocked by the endotracheal hyperplasia of inflammatory granulation tissue. Collapsed lung tissue were reexpantion in 16 patients (84.2%) after the first treatment, in 2 patients (10.5%) after twice inflation, while one case failed even after three times treatment (5.3%). During the procedure, the vital signs of all patients'were stable and no complications. Conclusion:Constant-pressure expanding of the ipsilateral lung throughout bronchial intubation is a safe and effective treatment for postoperatively intractable atelectasis.