Perioperative outcomes of single-lumen versus double-lumen endotracheal tube in totally thoracoscopic cardiac surgery: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Zhenzhong ¹ , XIAO Shuo ¹ , FANG Dou ² , LI Yuxin ² , WEI Jinfeng ² , YE Yingxian ² , ZHANG Jianjun ² , GUO Xiaogang ² ,  ZENG Qingshi ² ,  HUANG Huanlei ^1,2

1. School of Medicine, South China University of Technology, Guangzhou, 510006, P. R. China;
2. Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, P. R. China;

Corresponding author：

ZENG Qingshi, Email: 1963088488@qq.com; HUANG Huanlei, Email: huanghuanlei@gdph.org.cn

Keywords：

Single-lumen endotracheal tube; double-lumen endotracheal tube; postoperative pulmonary complications; totally thoracoscopic cardiac surgery

DOI：

10.7507/1007-4848.202301008

Video：

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Objective To investigate the relationship between two-lung ventilation (TLV) with single-lumen endotracheal tube (SLT), one-lung ventilation (OLV) with double-lumen endotracheal tube (DLT) and postoperative pulmonary complications (PPCs) after total thoracoscopic cardiac surgery. Methods The clinical data of patients who underwent totally thoracoscopic cardiac surgeries in the Guangdong Provincial People’s Hospital from October 2019 to October 2021 were retrospectively analyzed. The patients were divided into 2 group according to the type of endotracheal tube, including a SLT group and a DLT group. Baseline data, surgical variables and PPCs were compared. The influencing factors of PPCs in the two groups were analyzed by binary logistic regression analysis. Results Finally 349 patients were enrolled, including 180 males and 169 females with an average age of 50.0±14.8 years. There were 219 patients in the SLT group and 130 patients in the DLT group. There was no statistical difference in baseline data, surgical variables or PPCs between the two groups (P＞0.05). Binary logistic regression analysis showed that PPCs were related to body mass index in the SLT group (OR=0.778, 95%CI 0.637 to 0.951, P=0.014) and preoperative smoking history in the DLT group (OR=0.058, 95%CI 0.004 to 0.903, P=0.042). Conclusion For the patients who undergo totally thoracoscopic cardiac surgery, TLV with SLT and OLV with DLT show no significant association with PPCs. At the same time, PPCs are associated with body mass index in the SLT group, while associated with preoperative smoking history in the DLT group.

1.	Chuang KH, Lai HH, Chen Y, et al. Improvement of surgical complications using single-lumen endotracheal tube intubation and artificial carbon dioxide pneumothorax in esophagectomy: A meta-analysis. J Cardiothorac Surg, 2021, 16(1): 100.
2.	Zhao M, Jiang T, Li M, et al. Video-assisted thoracoscopic total thymectomy: Two-lung ventilation with artificial pneumothorax. Minim Invasive Ther Allied Technol, 2020, 29(6): 380-384.
3.	Kim HY, Baek SH, Je HG, et al. Comparison of the single-lumen endotracheal tube and double-lumen endobronchial tube used in minimally invasive cardiac surgery for the fast track protocol. J Thorac Dis, 2016, 8(5): 778-783.
4.	邓友明, 殷国平, 张维峰, 等. 小潮气量快频率间歇正压通气在患儿胸腔镜手术中的应用. 临床麻醉学杂志, 2016, 32(1): 86-88.Deng YM, Yin GP, Zhang WF, et al. Application of small tidal volume, fast frequency intermittent positive pressure ventilation in thoracoscopic surgery for pediatric patients. J Clin Anesthesiol, 2016, 32(1): 86-88.
5.	Jammer I, Wickboldt N, Sander M, et al. Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine: European Perioperative Clinical Outcome (EPCO) definitions: A statement from the ESA-ESICM joint taskforce on perioperative outcome measures. Eur J Anaesthesiol, 2015, 32(2): 88-105.
6.	Mathis MR, Duggal NM, Likosky DS, et al. Intraoperative mechanical ventilation and postoperative pulmonary complications after cardiac surgery. Anesthesiology, 2019, 131(5): 1046-1062.
7.	Zochios V, Klein AA, Gao F. Protective invasive ventilation in cardiac surgery: A systematic review with a focus on acute lung injury in adult cardiac surgical patients. J Cardiothorac Vasc Anesth, 2018, 32(4): 1922-1936.
8.	Ibañez J, Riera M, Amezaga R, et al. Long-term mortality after pneumonia in cardiac surgery patients: A propensity-matched analysis. J Intensive Care Med, 2016, 31(1): 34-40.
9.	Branson RD. The scientific basis for postoperative respiratory care. Respir Care, 2013, 58(11): 1974-1984.
10.	Onifade A, Lemon-Riggs D, Smith A, et al. Comparing the rate of fiberoptic bronchoscopy use with a video double lumen tube versus a conventional double lumen tube-a randomized controlled trial. J Thorac Dis, 2020, 12(11): 6533-6541.
11.	Cerfolio RJ, Bryant AS, Sheils TM, et al. Video-assisted thoracoscopic surgery using single-lumen endotracheal tube anesthesia. Chest, 2004, 126(1): 281-285.
12.	Horswell JL. Anesthetic techniques for thoracoscopy. Ann Thorac Surg, 1993, 56(3): 624-629.
13.	Liu TT, Li L, Wan L, et al. Videolaryngoscopy vs. Macintosh laryngoscopy for double-lumen tube intubation in thoracic surgery:A systematic review and meta-analysis. Anaesthesia, 2018, 73(8): 997-1007.
14.	Vernick WJ, Woo JY. Anesthetic considerations during minimally invasive mitral valve surgery. Semin Cardiothorac Vasc Anesth, 2012, 16(1): 11-24.
15.	Narayanaswamy M, McRae K, Slinger P, et al. Choosing a lung isolation device for thoracic surgery: A randomized trial of three bronchial blockers versus double-lumen tubes. Anesth Analg, 2009, 108(4): 1097-1101.
16.	Wittenstein J, Scharffenberg M, Ran X, et al. Effects of body position and hypovolemia on the regional distribution of pulmonary perfusion during one-lung ventilation in endotoxemic pigs. Front Physiol, 2021, 12: 717269.
17.	Zorrilla-Vaca A, Grant MC, Rehman M, et al. Postoperative hypoxemia after dual-controlled vs volume-controlled ventilation in lung surgery. Ann Thorac Surg, 2023, S0003-4975(23): 00003-6.
18.	Lederman D, Easwar J, Feldman J, et al. Anesthetic considerations for lung resection: Preoperative assessment, intraoperative challenges and postoperative analgesia. Ann Transl Med, 2019, 7(15): 356.
19.	Duggan M, Kavanagh BP. Pulmonary atelectasis: A pathogenic perioperative entity. Anesthesiology, 2005, 102(4): 838-854.
20.	Richard JC, Brochard L, Breton L, et al. Influence of respiratory rate on gas trapping during low volume ventilation of patients with acute lung injury. Intensive Care Med, 2002, 28(8): 1078-1083.
21.	Acute Respiratory Distress Syndrome Network, Brower RG, Matthay MA, et al. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med, 2000, 342(18): 1301-1308.
22.	Zaidi SAA, Saleem K. Obesity as a risk factor for failure to wean from ECMO: A systematic review and meta-analysis. Can Respir J, 2021, 2021: 9967357.
23.	Mokhlesi B, Masa JF, Brozek JL, et al. Evaluation and management of obesity hypoventilation syndrome. An official American Thoracic Society clinical practice guideline. Am J Respir Crit Care Med, 2019, 200(3): e6-e24.
24.	Miskovic A, Lumb AB. Postoperative pulmonary complications. Br J Anaesth, 2017, 118(3): 317-334.

1. Chuang KH, Lai HH, Chen Y, et al. Improvement of surgical complications using single-lumen endotracheal tube intubation and artificial carbon dioxide pneumothorax in esophagectomy: A meta-analysis. J Cardiothorac Surg, 2021, 16(1): 100.
2. Zhao M, Jiang T, Li M, et al. Video-assisted thoracoscopic total thymectomy: Two-lung ventilation with artificial pneumothorax. Minim Invasive Ther Allied Technol, 2020, 29(6): 380-384.
3. Kim HY, Baek SH, Je HG, et al. Comparison of the single-lumen endotracheal tube and double-lumen endobronchial tube used in minimally invasive cardiac surgery for the fast track protocol. J Thorac Dis, 2016, 8(5): 778-783.
4. 邓友明, 殷国平, 张维峰, 等. 小潮气量快频率间歇正压通气在患儿胸腔镜手术中的应用. 临床麻醉学杂志, 2016, 32(1): 86-88.Deng YM, Yin GP, Zhang WF, et al. Application of small tidal volume, fast frequency intermittent positive pressure ventilation in thoracoscopic surgery for pediatric patients. J Clin Anesthesiol, 2016, 32(1): 86-88.
5. Jammer I, Wickboldt N, Sander M, et al. Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine: European Perioperative Clinical Outcome (EPCO) definitions: A statement from the ESA-ESICM joint taskforce on perioperative outcome measures. Eur J Anaesthesiol, 2015, 32(2): 88-105.
6. Mathis MR, Duggal NM, Likosky DS, et al. Intraoperative mechanical ventilation and postoperative pulmonary complications after cardiac surgery. Anesthesiology, 2019, 131(5): 1046-1062.
7. Zochios V, Klein AA, Gao F. Protective invasive ventilation in cardiac surgery: A systematic review with a focus on acute lung injury in adult cardiac surgical patients. J Cardiothorac Vasc Anesth, 2018, 32(4): 1922-1936.
8. Ibañez J, Riera M, Amezaga R, et al. Long-term mortality after pneumonia in cardiac surgery patients: A propensity-matched analysis. J Intensive Care Med, 2016, 31(1): 34-40.
9. Branson RD. The scientific basis for postoperative respiratory care. Respir Care, 2013, 58(11): 1974-1984.
10. Onifade A, Lemon-Riggs D, Smith A, et al. Comparing the rate of fiberoptic bronchoscopy use with a video double lumen tube versus a conventional double lumen tube-a randomized controlled trial. J Thorac Dis, 2020, 12(11): 6533-6541.
11. Cerfolio RJ, Bryant AS, Sheils TM, et al. Video-assisted thoracoscopic surgery using single-lumen endotracheal tube anesthesia. Chest, 2004, 126(1): 281-285.
12. Horswell JL. Anesthetic techniques for thoracoscopy. Ann Thorac Surg, 1993, 56(3): 624-629.
13. Liu TT, Li L, Wan L, et al. Videolaryngoscopy vs. Macintosh laryngoscopy for double-lumen tube intubation in thoracic surgery:A systematic review and meta-analysis. Anaesthesia, 2018, 73(8): 997-1007.
14. Vernick WJ, Woo JY. Anesthetic considerations during minimally invasive mitral valve surgery. Semin Cardiothorac Vasc Anesth, 2012, 16(1): 11-24.
15. Narayanaswamy M, McRae K, Slinger P, et al. Choosing a lung isolation device for thoracic surgery: A randomized trial of three bronchial blockers versus double-lumen tubes. Anesth Analg, 2009, 108(4): 1097-1101.
16. Wittenstein J, Scharffenberg M, Ran X, et al. Effects of body position and hypovolemia on the regional distribution of pulmonary perfusion during one-lung ventilation in endotoxemic pigs. Front Physiol, 2021, 12: 717269.
17. Zorrilla-Vaca A, Grant MC, Rehman M, et al. Postoperative hypoxemia after dual-controlled vs volume-controlled ventilation in lung surgery. Ann Thorac Surg, 2023, S0003-4975(23): 00003-6.
18. Lederman D, Easwar J, Feldman J, et al. Anesthetic considerations for lung resection: Preoperative assessment, intraoperative challenges and postoperative analgesia. Ann Transl Med, 2019, 7(15): 356.
19. Duggan M, Kavanagh BP. Pulmonary atelectasis: A pathogenic perioperative entity. Anesthesiology, 2005, 102(4): 838-854.
20. Richard JC, Brochard L, Breton L, et al. Influence of respiratory rate on gas trapping during low volume ventilation of patients with acute lung injury. Intensive Care Med, 2002, 28(8): 1078-1083.
21. Acute Respiratory Distress Syndrome Network, Brower RG, Matthay MA, et al. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med, 2000, 342(18): 1301-1308.
22. Zaidi SAA, Saleem K. Obesity as a risk factor for failure to wean from ECMO: A systematic review and meta-analysis. Can Respir J, 2021, 2021: 9967357.
23. Mokhlesi B, Masa JF, Brozek JL, et al. Evaluation and management of obesity hypoventilation syndrome. An official American Thoracic Society clinical practice guideline. Am J Respir Crit Care Med, 2019, 200(3): e6-e24.
24. Miskovic A, Lumb AB. Postoperative pulmonary complications. Br J Anaesth, 2017, 118(3): 317-334.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

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