Prediction Of Smooth Non-intubated Thoracoscopic Lobectomy Through Pulmonary Function Test Values.
Kwanyong Hyun1, Gongmin Rim1, Sook Whan Sung2.
1Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea, Republic of, 2Ewha Womens University Seoul Hospital, Seoul, Korea, Republic of.
BACKGROUND: We investigated the safety of non-intubated thoracoscopic lobectomy and patient factors vulnerable to non-intubated stress.
METHODS: A total of 126 patients were electively operated with non-intubated thoracoscopic lobectomy from August 2016 to May 2018. 117 patients were analyzed after exclusions (insufficient pulmonary function test data, conversion to tracheal intubation due to pleural adhesions). Pulmonary airflow disturbances were investigated with pulmonary function tests (PFT). Group V (vulnerable to non-intubated stress) included patients with unstable pulmonary gas exchange of a mean SpO2<95% and mean EtCO2>50, and in-danger patients with vigorous (significant) diaphragmatic and mediastinal movement that could hamper subsequent operative procedure.
RESULTS: The mean BMI of all patients was 23.6 with a mean operation time and hospital stay of 142 minutes and 6.6 days, respectively. 45 patients (38%) were classified to group V and 72 patients (62%) were classified to group NV (non-vulnerable to non-intubated stress). Group V showed a significant higher mean EtCO2 and a lower mean SpO2 during the one-lung ventilation when compared to group NV (45.3 vs 48.3, p=0.021; 100 vs. 97.6%, p=0.000). Four patients (3.4%) required conversion to tracheal intubation and all these patients were from group V. In multivariable analysis using clinical factors, group V is predicted by the presence of high BMI, low FVC and high airway resistance (Raw) (Fig. 1). The optimal cutoff value of BMI, FVC and Raw for predicting group V were 25.1, 3.06L, and 141%, respectively by ROC curve analysis (Fig. 2).
CONCLUSIONS: Our results support a policy of non-intubated procedure on thoracoscopic lobectomy in highly selected patients. We believe that more caution should be taken in doing non-intubated one-lung ventilation for patients with low functional reserve and high airway resistance.
LEGEND: Forest Plot for predictors of non-intubated stress.
LEGEND: ROC Curve Analysis for predictors of non-intubated stress, 
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