Clinical Observation Of The Side Bronchial Balloom Inflating Method In The Application Of Double-lumen Tube

BackgroundWith the rapid development of endoscopic equipment and minimally invasive technology,video-assisted thoracoscopy has been gradually applied in thoracic surgery,which requires lung isolation technique(LIT)and good Lung collapse,lung isolation makes each of them function as an independent unit to achieve selective one-lung ventilation(OLV),achieving by preparation of the airway through proper manipulation and instrumentation.This provides improved exposure of the surgical field,and protection of healthy lung from infected or bleeding one,to avoid drowning of healthy side lung,which may lead to bilateral pulmonary ventilation dysfunction.The use of double-lumen tube(DLT)for lung isolation and single lung ventilation is currently the most commonly used clinical method.The positioning of double-lumen tube was achieved mainly by auscultation and Fiberoptic bronchoscope(FOB)direct vision.Due to the blindness and subjectivity of the conventional auscultation positions,which is influenced by many factors,the accuracy and arrival rate are low.Fiberoptic bronchoscopy is currently considered the "gold standard" for determining the location of double-lumen tube.However,fiberoptic bronchoscopy is expensive and belongs to invasive treatment,which needs to be strictly disinfected after use.If multiple surgeries are needed at the same time,it is difficult to meet the demand,which make it cannot be popularized and cannot be used in much secretions or bleeding and other special circumstances,so all of them have shortcomings.In this study,by using the method of side bronchial balloom inflating method,that is,by partially inflating the side bronchial balloom to simulate the effect of carina hook for auxiliary positioning,completing the endotracheal intubation to increase the accuracy of double lumen endotracheal tube positioning with blind exploration and reduce the injury of patients.It provides strong clinical evidence for the selection of double lumen endotracheal localization method in clinical practice,especially for the patients who cannot use fiberoptic bronchoscopy to provide a better choice for the use of double lumen endotracheal.ObjectiveComparing to the the traditional auscultation method,to observe the effectiveness,accuracy and security of the side bronchial balloom inflating method in the application of single lung ventilation in thoracoscopic surgery.Methods80 adult patients who need selective operation,ASA?~?,requiring a left-side double lumen tube for one-lung ventilation were enrolled in this prospective study,aged 25 to 75 years old,male 56 cases,female 24 cases,37 cases of patients with lung cancer,31 cases with esophageal cancer,12 cases with mediastinal tumor.Randomly divided into ? and ? group,40 cases in each.After anesthesia induction,group ? with traditional auscultatory method,the patient was in a supine position,exposing the glottis as much as possible with the visual laryngoscope,after the vocal cords were observed,the concave front end of the DLT was slowly pushed forward toward the vocal cords until the side bronchial balloom was inserted into the glottis,pull out the tube core,the DLT overall sinistral 90 °,continue to move forward until you feel resistance,then connect the breathing circuit,adjusted by auscultation until satisfactory,marking the depth of the DLT.Group ? use side bronchial balloom inflating method that relies on partially inflating the bronchial balloon and recreating the effect of a carinal hook to give an idea of the placement of the DLT and complete the DLT intubation.the patient was in a supine position,exposing the glottis as much as possible with the visual laryngoscope,after the vocal cords were observed,the concave front end of the DLT was slowly pushed forward toward the vocal cords until the side bronchial balloom was inserted into the glottis,pull out the tube core,the DLT overall sinistral 90 °,and then bronchia-sided tube balloon was inflated with about 4 to 6ml air,continue to move slowly forward,until met with resistance,now we think the DLT lower edge of bronchia-sided tube balloon was expected to be just above the carina,the location where the DLT intersected with the upper incised teeth was marked,and then the air in the bronchial tube balloon was drained,then move forward 15 mm(About the length of the bronchial lateral catheter capsule).At this point,we believe that the upper edge of the bronchial lateral catheter capsule of the DLT is located just below the carina,and hen connect the breathing circuit to inflate the tracheal tube cuff,auscultate and adjust the position of the DLT until satisfactory,marking the depth of the DLT.After satisfactory auscultation in both groups,another anesthesiologist who did not know the method of intubation was examined and recorded the position of the intubation with fiberoptic bronchoscopy.The following data were recorded and evaluated:(1)to evaluate the time of the intubation,the success rate of one-time intubation,the adjustment times of the tube with these two intubation methods.(2)to evaluate hemodynamic changes of the two intubation methods: SBP?DBP and HRwere recorded at1 min before intubation(T1),intubation time(T2),1min after intubation(T3),3min after intubation(T4),5min after intubation(T5),and 10 min after intubation(T6).(3)to evaluate the degree of postoperative airway mucosal injury,hoarseness,sore throat and swallowing pain in patients with these two intubation methods.Results(1)compared to group?,the intubation time of group?was significantly shorter(P<0.05),the success rate of one-time intubation of group?was higher(P<0.05),the adjust times of DLT in group?was significantly fewer(P < 0.05);(2)There was no statistical difference between the two groups on hemodynamics(P > 0.05),but in group?,compared with the time T1,T2?T3?T4 moment of SBP,DBP and HR increased significantly(P < 0.05);in group?,compared with the time T1,T2?T3 moment of SBP,DBP and HR increased significantly(P < 0.05);At T4 time,SBP in group?was significantly higher than that in group?.(3)compared to group?,the incidence and degree of the postoperative airway mucosal injury and postoperative hoarseness,sore throat and swallowing pain in group?were significantly less(P<0.05).ConclusionThe side bronchial balloom inflating method has more advantages than the tradition auscultatory method in the positioning of DLT intubation.