Characteristics of Double-Lumen Tubes Determine Bronchial Airway Pressure

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• 作者：Johannes Spaeth ; MD ; ^{johannes.spaeth@uniklinik-freiburg.de" class="auth_mail" title="E-mail the corresponding author} ; Andrea Hojnik ; MD ; Matthias Ott ; Steffen Wirth ; MD ; Matthias Schneider ; Torsten Loop ; MD ; Stefan Schumann ; PhD
• 关键词：double-lumen tube ; one-lung ventilation ; artificial airway resistance ; bronchial pressure
• 刊名：Journal of Cardiothoracic and Vascular Anesthesia
• 出版年：2016
• 出版时间：August 2016
• 年：2016
• 卷：30
• 期：4
• 页码：954-960
• 全文大小：823 K

文摘

To determine pressure-flow characteristics of double-lumen tubes (DLTs) with an outer diameter of 26 to 41 French and calculate bronchial pressure in a model setup and using data from patients who underwent one-lung ventilation with a DLT.

Design

Prospective experimental study and retrospective analysis of clinical measurements.

Setting

University medical center.

Participants

Lung model and patients.

Interventions

Flow rates and pressure gradients across Robertshaw-type DLTs (∆P^DLT) were measured in a physical model and the DLT-specific resistance coefficients were calculated from ∆P^DLT according to Rohrer’s approach. Bronchial pressure was calculated from airway pressure and ∆P^DLT in a lung model and using data from 72 patients who underwent thoracic surgery and direct bronchial pressure measurements.

Measurements and Main Results

∆P^DLT increased with decreasing outer diameter of the DLT and more than doubled during one- compared with two-lung ventilation (p<0.001). ∆P^DLT differed between inspiration and expiration (p<0.05) and was higher across the tracheal lumen compared with the bronchial lumen (p<0.001). Root mean square differences between calculated and measured bronchial pressures were less than 0.7 cmH₂O in the lung model and less than 1.2 cmH₂O in the clinical measurements.

Conclusions

The DLTs’ pressure-flow characteristics differed considerably depending on size, mode of ventilation (one or two lung), direction of flow, and lumen for ventilation. Rohrer’s approach allowed for sufficient calculation of the bronchial airway pressure during both one- and two-lung ventilation.