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The incidence of postoperative pulmonary complications (PPCs) after thoracic surgery is as high as 30-50% [1-6], which is the main cause of postoperative morbidity, death and prolonged hospital stay. Optimization of risk factors in PPCs procedures is the focus of current research. Double lumen bronchial tube (DLT) is a commonly used lung isolation method for adult patients. It has the advantages of good lung isolation effect, sufficient exposure of the surgical field and easy to attract secretions in the airway. However, there are still some deficiencies in clinical precise positioning, long-term continuous detection during operation, early detection of catheter displacement and other emergencies. Continuous intra-airway monitoring is the main advantage of visual double-lumen bronchial catheter. It can quickly and easily determine the position of the catheter and quickly adjust the displacement, and timely and effectively clean up the secretion in the airway, which is conducive to the analysis and treatment of intraoperative hypoxemia. Whether these potential advantages can reduce the incidence of PPCs deserves our in-depth discussion. The research group randomly divided the patients who were scheduled to undergo thoracoscopic radical resection of lung cancer in the Union Hospital affiliated to Fujian Medical University into the test group (lung isolation with visible double-lumen bronchial catheter, continuous intra-airway monitoring and intervention) and the control group: (Pulmonary isolation was performed with visual double-lumen bronchial catheter, and only intra-airway video was performed without monitoring. The effect of continuous intra-airway monitoring under visual double-lumen bronchial catheter on postoperative complications of lung surgery was evaluated by Melbourne evaluation scale.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Test group (group T) | Experimental | lung isolation was performed with visual double-lumen bronchial catheter, andcontinuous airway monitoring and intervention were performed |
|
| Control group (group C) | No Intervention | lung isolation was performed with visual double-lumen bronchial catheter, and only intra-airway video was performed without monitoring |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Continuous intra-airway monitoring and intervention during surgey | Procedure | Continuous monitoring was performed by visual double lumen bronchial catheter. Once sputum or blood gushing into the tracheal carina was found in the distal bronchus on the surgical side, the above secretions were sucked out with a sputum suction tube under video monitoring until the removal was complete |
| Measure | Description | Time Frame |
|---|---|---|
| Incidence of pulmonary complications | Evaluation of the incidence of pulmonary complications three days after surgery by the Melbourne Assessment Scale Melbourne Group Scale(Minimum value 0 points ;Max 8 points
If 4 or more of the above 8 items are satisfied, the subject is considered to have developed pulmonary complications. | 3 days after operation |
| Measure | Description | Time Frame |
|---|---|---|
| Double lumen tube displacement | The number of times that fiberoptic bronchoscopy should be used to check or adjust the position during the operation, the rate of displacement, the degree of displacement, the number and time of operation suspension due to the adjustment of the position of double-lumen tube, etc Position adjustment assisted by fiberoptic(Check only unadjusted available at the back □ mark ×) □NO : 1stTime:|__|__|min|__|__|second;□ 2stTime:|__|__|min|__|__|second:□ 3stTime:|__|__|min|__|__|second:□ □YES: 1stTime:|__|__|min|__|__|second;□ 2stTime:|__|__|min|__|__|second:□ 3stTime:|__|__|min|__|__|second:□ |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Ye Chen, Master | Contact | 13906916355 | 1211020165@fjmu.edu.cn | |
| Xiaodong Xu, Master | Contact | 18650055080 | mamao_83@fjmu.edu.cn |
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|
| during the operation |
| Intubation effectiveness | Time taken for successful intubation and positioning (time from laryngoscope exposure to successful positioning of double lumen bronchial tube), success rate of first intubation and positioning, and probability of using fiber bronchoscopy for positioning
| during the operation |
| Hypoxemia during operation | Intraoperative SPO2<90% □ Yes □ No
| during the operation |
| Intraoperative carbon dioxide accumulation | PaCO2>45mmHg:□ No □ Yes: Duration|__|__| Minutes|__|__| Seconds; | during the operation |
| Incidence of tracheal intubation complications | Incidence of postoperative sore throat, hoarseness, etc. | three days after operation |
| Lung atrophy quality | Lung atrophy quality during the operation(The condition is judged by the thoracic surgeon) 口Excellent visual field exposure, complete collapse of lung 口Medium The lungs are basically collapsed, but there's still residual air 口Poor Partial collapse or even non-collapse of the lung requires surgical intervention to expose the visual field | during the operation |
| Effectiveness of sputum suction |
| Postoperative |