Single-lumen Tube Are Associated With Improved Oxygenation In Patients Undergoingthoracoscopic Cardiac Surgery:a Prospective Study
Zhenzhong Wang, Huanlei Huang, Shuo Xiao, Qiuji Wang, Yuxin Li, Yingxian Ye, Kan Zhou, Xiaogang Guo, Qingshi Zeng.
Guangdong General Hospital, Guangzhou, China.
BACKGROUND:The two-lung ventilation(TLV) with single-lumen endotracheal tube (SLT) at high frequency and low tidal volume is beneficial in patients undergoing thoracoscopic non-cardiac surgery. However, whether it is beneficial in patients accepting thoracoscopic cardiac surgery is unclear.
METHODS:From Dec 2021 through Nov 2022, 138 patients underwent thoracoscopic cardiac valvular surgery were randomly divided into two groups: one-lung ventilation(OLV) with double-lumen endotracheal tube(DLT) group and TLV with SLT group in this prospective observational study. The pattern of OLV: fraction of inspiration O2 (FiO2) =100%, tidal volume (TV) =5 ml/Kg, respiratory rate(RR)=17 times/min. Meanwhile, FiO2=100%, TV=3 ml/Kg, RR=30 times/min in TLV. Surgical variables, oxygenation, and respiratory complications were assessed over a 15-day follow-up period. Oxygenation was assessed by blood gas analysis at five key points: after anesthesia(T1), before CPB (T2), during CPB (T3), after CPB (T4) and in the intensive care unit(T5). The blood gas analysis at T2 and T4 were obtained 10 minutes after the above mechanical ventilation were set.
RESULTS:No significant differences in baseline data, surgical variables and respiratory complications between the two groups. The SLT group had significantly higher SaO2(P<0.001),PaO2(P<0.001),SvO2(P<0.001)and PvO2(P<0.001) at T2 and T4. Therefore, the SLT group had significantly lower incidence of hypoxia at T2(1.4% vs 41.2%; P<0.001) and T4(20.0% vs 67.6%; P<0.001). However, the PaCO2 in the SLT group was significantly increased. The median PaCO2 was 48mmHg at T2 and 51.5mmHg at T4. Older age, lower preoperative hematocrit and albumin were more likely to be associated with postoperative hypoxemia in DLT group.
CONCLUSIONS:The pattern of two-lung ventilation with single-lumen endotracheal tube at high frequency and low tidal volume can achieve a good balance between the exposure of surgical field and the improvement of oxygenation. It is worth trying in thoracoscopic cardiac surgery.
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