Jiayun Li, Wu Liu, Xi Liang, Ren Zhou, Mingsong Wang, Beibei Hu, Hong Jiang, Rong Hu
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Comparing the lung isolation efficacy of bronchial blocker positioning via electromagnetic navigation bronchoscopy versus fiberoptic bronchoscopy: a randomized study.
Background: The inflated balloon of a bronchial blocker (BB) obstructs the mainstem bronchus, allowing controlled ventilation of one lung while collapsing the other for lung isolation during thoracic surgery. We compared the effects of lung isolation using electromagnetic navigation bronchoscopy (ENB)-guided versus fiberoptic bronchoscopy (FOB)-guided BB placement to provide a novel BB positioning method for airway management during thoracic anesthesia.
Methods: We randomly divided 106 patients who underwent elective one-lung ventilation (OLV) with intraoperative ENB usage into ENB and FOB groups. We compared subjective lung collapse scores, time required for correct BB placement, incidence of BB malposition, and frequency of intraoperative BB repositioning with FOB between the groups. Heart rate (HR) and mean arterial pressure were recorded before intubation of single-lumen tracheal tube, and before and after BB positioning. Blood gas levels were measured before and at 10 and 30 min after initiating OLV. Postoperative follow-up indices, including blood cell analysis, C-reactive protein levels, and pulmonary complications, were also recorded.
Results: The subjective lung collapse score was significantly higher in the ENB group than in the FOB group [9.08 (1.36) vs. 8.24 (1.93), P=0.01]. The time required for correct BB placement was significantly shorter in the ENB group than in the FOB group [13.00 (10.00, 20.25) vs. 49.00 (35.00, 75.00), P<0.001]. However, the incidence of BB malposition, frequency of intraoperative BB repositioning with FOB, HR, mean arterial and peak airway pressure before and after BB positioning, arterial blood gas analysis, and postoperative follow-up indices did not differ significantly between the two groups.
Conclusions: ENB-guided BB positioning is an efficient method of lung isolation, demonstrating superior and more rapid lung collapse effects compared with conventional FOB-guided BB placement.
Trial registration: The trial was registered on China Clinical Trial Registry (registration No. ChiCTR2300076133).
期刊介绍：
The Journal of Thoracic Disease (JTD, J Thorac Dis, pISSN: 2072-1439; eISSN: 2077-6624) was founded in Dec 2009, and indexed in PubMed in Dec 2011 and Science Citation Index SCI in Feb 2013. It is published quarterly (Dec 2009- Dec 2011), bimonthly (Jan 2012 - Dec 2013), monthly (Jan. 2014-) and openly distributed worldwide. JTD received its impact factor of 2.365 for the year 2016. JTD publishes manuscripts that describe new findings and provide current, practical information on the diagnosis and treatment of conditions related to thoracic disease. All the submission and reviewing are conducted electronically so that rapid review is assured.
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