Techniques for Lung Deflation With Arndt® Blocker
The use of wire-guided Arndt® endobronchial blocker does not gain widespread acceptance during video-assisted thoracoscopy (VATS) because it takes longer time to collapse the operative lung especially in patients with chronic obstructive lung disease (COPD). The use of a disconnection technique for deflation of Arndt® blocker had a comparable degree of lung collapse with the use of double-lumen tubes. However, it carries a risk of blood or infected secretions contaminating the dependent lung.
We hypothesise that the use bronchial suction of through a barrel part of a 1-mL insulin syringe attached to the suction port of the bronchial blocker would be associated with comparable time to optimum lung collapse with the disconnection technique.
After ethical approval, 58 patients with spontaneous pneumothorax scheduled for elective VATS using Arndt blocker® for lung separation will be included in this prospective, randomized, double-blind study.
Patients will be randomly assigned to deflate the blocker with either disconnecting the endotracheal tube from the ventilator for 60 s. prior to inflation of the bronchial blocker allowing both lungs to collapse, or attaching -20 cm H2O of suction to the suction port of the blocker through the barrel part of a 1-mL insulin syringe (n = 29 for each group).
|Spontaneous Pneumothorax||Other: Disconnection group Other: Bronchial Suction group||Phase 2|
|Study Design:||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
|Official Title:||Lung Deflation With Arndt® Blocker During Video-Assisted Thoracoscopy: A Comparison of the Disconnection Technique With a Continuous Bronchial Suction|
- time needed for lung collapse [ Time Frame: 3 min before one lung ventilation ]measured from the institution of OLV to the time of total lung collapse
- quality of lung collapse [ Time Frame: every 20 min intervals after one lung ventilation initiation ]The quality of lung collapse at 20 min intervals after one lung ventilation initiation according to a four-point ordinal scale,3, 8 ranging from 1 (extremely poor) to 4 (excellent). Extremely poor (Score 1) indicated no collapse; poor (Score 2) indicated that there is a partial collapse with interference with surgical exposure; good (Score 3) indicated that there is total collapse, but the lung still had residual air; and excellent (Score 4) indicated a complete collapse with perfect surgical exposure. The feasibility of this scale was investigated during six surgical procedures not included in the study.
- Overall surgeon satisfaction [ Time Frame: 15 min after surgery ]Overall surgeon satisfaction with surgical conditions as assessed using a verbal analog scale (0 = unsatisfied to 10 = very satisfied)
- Number of times that the fiberoptic bronchoscope required to assure proper position [ Time Frame: 5 min after reinflation of the surgical lung ]The number of times that the FOB was required to assure proper position or to perform further bronchial suction
- Intraoperative hypoxemia [ Time Frame: For 2 hours during surgery ]Intraoperative hypoxemia (SaO2 < 92%)
|Study Start Date:||January 2014|
|Study Completion Date:||April 2014|
|Primary Completion Date:||March 2014 (Final data collection date for primary outcome measure)|
Active Comparator: Disconnection group
The single lumen tube was disconnected from the ventilator for 60 s allowing the surgical lung to collapse.
Other: Disconnection group
The blocker cuff was deflated, the single lumen tube was disconnected from the ventilator for 60 s allowing the surgical lung to collapse, then the cuff was re-inflated with the same amount of air as determined previously and the ventilator was reconnected to the single lumen tube
Active Comparator: Bronchial Suction group
The suction port of the bronchial blocker, and connected to -30 cm H2O of suction.
Other: Bronchial Suction group
The barrel part of a 1-mL insulin syringe was attached to the suction port of the bronchial blocker, and connected to -30 cm H2O of suction.
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Please refer to this study by its ClinicalTrials.gov identifier: NCT02030795
|Al Khubar, Eastern, Saudi Arabia, 31952|