Double lumen tube location predicts tube malposition and hypoxaemia during one lung ventilation
Double lumen tube location predicts tube malposition and hypoxaemia during one lung ventilation
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DOI：
10.1093/bja/aeh055
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发表时间：
2004-02-01
影响因子：
9.8
通讯作者：
Taniguchi, S
中科院分区：
文献类型：
--
作者：
Inoue, S;Nishimine, N;Taniguchi, S
背景。支气管内双腔管（DLT）定位不良可能影响单肺通气（OLV）时的氧合。我们开始将DLT位置与olv期间低氧血症和DLT错位联系起来。我们招募了152名ASA身体状况为I-II的即将进行择期胸外科手术的患者。气管插管采用左侧DLT。通过光纤镜评估管的位置，并在患者定位后和OLV期间进行纠正。如果pa - o2小于10.7 kPa，检查DLT位置，然后尝试PEEP、持续气道正压通气（CPAP）、氧注入或两肺通气（TLV）。49例患者（32%）在患者定位后发现DLT错位，38例患者（25%）在OLV期间发现DLT错位。46例（30%）患者对依赖肺进行了PEEP，对非依赖肺进行了CPAP或无氧呼吸，或短时间的TLV。侧位放置后DLT错位的患者在OLV期间DLT错位的发生率更高（59比9%），并且每次干预的频率也更高（57比10%）。在OLV期间DLT错位的患者也需要更多的干预（84比12%）。侧位放置后出现DLT错位的患者在OLV期间DLT错位较多，OLV期间低氧血症较多。
Background. Poor positioning of an endobronchial double lumen tube (DLT) could affect oxygenation during one lung ventilation (OLV). We set out to relate DLT position to hypoxaemia and DLT misplacement during OLV.Methods. We recruited 152 ASA physical status I-II patients about to have elective thoracic surgery. The trachea was intubated with a left-sided DLT. Tube position was assessed by fibre-optic scope and correction was made after patient positioning and during OLV. If Pa-O 2 was less than 10.7 kPa, the DLT position was checked and then PEEP, continuous positive airway pressure (CPAP), oxygen insufflation, or two lung ventilation (TLV) were tried.Results. The DLT was found to be misplaced in 49 patients (32%) after patient positioning, and in 38 patients (25%) during OLV. PEEP to the dependent lung, CPAP or apneic oxygen insufflation to the non-dependent lung, or brief periods of TLV, were applied in 46 patients (30%). Patients who had DLT malposition after placing the patient in the lateral position had a greater incidence of DLT malposition during OLV (59 vs 9%) and also required each intervention more frequently (57 vs 10%). Patients with DLT malposition during OLV also required interventions more often (84 vs 12%).Conclusions. Patients who have DLT malposition after placing the patient in the lateral position had more DLT malposition during OLV and hypoxaemia during OLV.