Application Of Video Double-lumen Bronchial Tube In Thoracoscopy Surgery

ObjectiveDouble lumen tube（DLT）is the most commonly used lung isolation device for single lung ventilation（OLV）in minimally invasive thoracic surgery.Currently,fiberoptic bronchoscopy（FOB）is mainly used clinically to locate DLT,but it is difficult to use,time-consuming and easy to cause hypoxemia.Therefore,finding an alternative method to accurately and quickly locate DLT is of great significance to prevent complications and improve patient recovery.This study comprehensively evaluated the time taken for intubation positioning,single-lung ventilation effect,FOB usage rate,and adverse events of video double lumen tube（VDLT）and ordinary DLT during thoracoscopic surgery to evaluate the efficiency and safety of the new visualization catheter in patients undergoing thoracoscopic lung surgery.Methods1、Selected ASA I-III grade adult patients who underwent thoracoscopic lung surgery under elective general anesthesia in People’s Hospital of Zhengzhou University.The exclusion criteria are as follows:those with bronchial stenosis and any other diseases that affect the placement of the double-lumen tube;those with laryngeal edema,acute inflammation of the larynx,and giant aneurysms;those with severe cardiopulmonary dysfunction and those who have previously undergone thoracic surgery or have a history of chest radiotherapy;Those with a history of hypertension;those with difficult airway prediction;those who need to use other lung isolation equipment or techniques for surgery（such as tracheotomy,nasal intubation,etc.）.A total of 100 patients were enrolled,including 45 males and 55 females,aged18-75 years,BMI 18-28 kg/m2,54 left DLT,46 right DLT,and the operation time was 1-4 hours.2、Grouping:The random number table method was used to randomly divide the patients into the ordinary double-lumen bronchial intubation group（DLT group）and the visual double-lumen bronchial intubation group（VDLT group）,with 50 cases in each group.3.Anesthesia methods:After the patients enter the room to monitor the vital signs,they are all induced quickly through the vein.After the muscle relaxation is fully effective,the same experienced anesthesiologist will perform bronchial intubation and positioning.In the VDLT group,the catheter was connected to the monitor before intubation.When the image was clearly visible,anesthesia was induced,the glottis was exposed through the visual laryngoscope,and the catheter was inserted,and the positioning was guided by the image on the monitor.DLT group:After exposing the glottis through a visual laryngoscope,a catheter was inserted,and the DLT was advanced until the endobronchial cuff crossed the vocal cords.After a slight resistance was felt,the FOB assisted positioning.The patient underwent thoracic paravertebral nerve block（TPVB）after taking the surgical position.After the lateral position,before the start of one-lung ventilation,the VDLT group observed the catheter displacement through video,and the DLT group reconfirmed the catheter position via FOB,and adjusted it if necessary.One-lung ventilation is started before the pleura is opened.The anesthesia is maintained by a combined method of static suction.After the operation,the lungs are sucked and sent to the post-anaesthesia recovery room（PACU）for recovery and extubation.4.Observation indicators:（1）preoperative:record baseline characteristics and preoperative evaluation data of the two groups of patients;（2）during intubation:record the intubation time of the two groups of patients（from the beginning of exposure of the glottis with the laryngoscope to the passage of the main cuff of the tracheal tube Time）,positioning time（the time taken from the time the main catheter cuff crosses the glottis to the successful positioning）,the success rate of one intubation,and the use rate of FOB during positioning.In the VDLT group,when the video-guided positioning fails,FOB is used to assist positioning;the baseline（T0）,before intubation（T1）,intubation（T2）,successful positioning（T3）,and 3min after successful positioning are recorded in the two groups.T4)MAP,HR,Sp O₂ values at5 time points;（3）Intraoperative:Record the catheter displacement rate,FOB usage rate and the time required for the adjustment of catheter displacement at each node after the two groups of patients are laterally positioned.Intraoperative airway pressure>40cm H₂O,SPO₂<90%,or the surgeon’s assessment of lung collapse was defined as misalignment.The DLT group uses FOB to check and adjust the positioning,the VDLT group uses the display to adjust the positioning,and when the ventilation does not improve,use the FOB to assist the positioning;Record the lung ventilation effect of the two groups of patients:the surgeon single-blindly assessed the degree of lung collapse at 0 min and 5 min after the pleura was opened;（4）Recorded and assessed the quality of the view on the monitor in the VDLT group:divided into level A:trachea can be observed,A complete view of the anterior and posterior walls of the carina and bronchus;Level B:Only a partial view of the anterior and posterior walls;Level C:Anatomy and/or positioning cannot be identified;（5）Adverse events:The incidence of intraoperative hypoxemia,the incidence and degree of sore throat and hoarseness within 24 hours after operation were recorded in the two groups.At the level of P<0.05,SPSS 25.0 was used to statistically analyze the observation indicators of the two groups of patients.Results1.There was no statistical difference between the two groups of patients in general information,operation type,operation time,and double-lumen tube type（P>0.05）.2.Intubation positioning:Compared with the DLT group,the positioning time of the VDLT group was significantly shorter,and the difference between the two groups was statistically significant（P<0.01）.Compared with 100%（50/50）in the DLT group,the final position of the catheter using FOB in the VDLT group was 10%（5/50）.VDLT significantly reduced the FOB usage rate（P<0.01）.There was no significant difference in intubation success rate and intubation time between the two groups（P>0.05）.3.Catheter displacement of the two groups of patients:Compared with the DLT group,the use of VDLT intubation significantly reduced the time required for catheter displacement adjustment（P<0.01）.Compared with 100%（13/13）in the DLT group,the VDLT group used FOB to adjust the positioning to 20%（2/10）.VDLT significantly reduced the FOB usage rate（P<0.01）.There was no significant difference in the lateral position and intraoperative catheter displacement rate between the two groups（P>0.05）.4.Hemodynamics:When compared with the DLT group,the difference in MAP and HR at T2 and T3 time points when using VDLT intubation and positioning was statistically significant（P<0.05）,and at T0,T1,and T4 time points There was no statistically significant difference in MAP and HR（P>0.05）.There was no significant difference in Sp O₂ between the two groups of patients at 5 time points（P>0.05）.5.The degree of lung collapse of the two groups of patients:Compared with the DLT group,there was no statistically significant difference in the degree of lung collapse of patients in the VDLT group at 0 min and 5 min after the pleura opened（P>0.05）,and satisfactory lung atrophy can be achieved.trap.6.VDLT perioperative monitoring function:VDLT video quality score:A-level43 cases;B-level 4 cases;C-level 3 cases,of which 7 cases had video blur,5 cases recovered clearly after washing,which can achieve good monitoring functions.7.Adverse events:There was no statistically significant difference in the incidence of intraoperative hypoxemia（P>0.05）.The incidence of postoperative sore throat in the VDLT group was significantly lower than that in the DLT group（P<0.05）,and the difference was statistically significant.There was no statistical difference in the incidence of hoarseness（P>0.05）.There was no significant difference in the severity of postoperative sore throat and hoarseness between the two groups（P>0.05）.ConclusionVDLT can continuously visualize the tracheal mucosa,carina and proximal airway of the bronchus.The intubation can be positioned quickly and accurately,and is highly efficient;the use of VDLT for intubation reduces the FOB usage rate during the initial positioning and adjustment of displacement,facilitates the operation and can guarantee With good one-lung ventilation effect,VDLT can partially replace FOB in clinical application;VDLT intubation is less irritating,and the incidence of postoperative complications is low.VDLT can be used as the preferred equipment for clinical implementation of lung isolation technology.