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3D CT airway evaluation-guided intraluminal placement of endobronchial blocker in pediatric patients: a randomized
Yingyi Xu1, Le Li2, Jianning Hou3
1Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
Insights
Preoperative 3D computed tomography (CT) airway evaluation offers an effective method for guiding endobronchial blocker placement in pediatric patients undergoing thoracic surgery. This CT-guided approach demonstrates comparable blocking efficiency to traditional bronchoscopy (BRO) methods.
Area of Science:
- Pediatric Anesthesiology
- Thoracic Surgery
- Medical Imaging
Background:
- Endobronchial blocker placement is crucial for one-lung ventilation (OLV) during thoracic surgery.
- Traditional bronchoscopy (BRO) guidance has limitations in pediatric airway assessment.
- 3D computed tomography (CT) offers detailed airway visualization.
Purpose of the Study:
- To introduce and evaluate a novel 3D CT airway evaluation-guided endobronchial blocker placement technique.
- To compare the clinical efficacy of CT-guided versus BRO-guided blocker placement in pediatric patients.
Main Methods:
- A randomized controlled trial involving 127 pediatric patients (0.5-3 years) undergoing elective thoracic surgery with OLV.
- Patients were assigned to either a bronchoscopy (BRO) group or a CT-guided group.
- Outcomes assessed included lung collapse, airway injury, infection, hoarseness, ventilation duration, ICU stay, hospitalization, and blocker placement success rates.
Main Results:
- No significant differences were observed between the CT and BRO groups in lung collapse, airway mucosal injury, or postoperative pulmonary infection.
- Duration of mechanical ventilation, ICU stay, and hospitalization were similar between groups.
- Success rates, time, and repositioning required for blocker placement did not differ significantly between the CT-guided and BRO-guided methods.
Conclusions:
- Preoperative 3D CT airway evaluation is a viable alternative for guiding endobronchial blocker placement in pediatric patients.
- CT-guided blocker placement achieves similar efficacy to BRO-guided placement for OLV in pediatric thoracic surgery.
- This technique provides a comparable alternative for ensuring effective lung isolation in young surgical patients.
Background:
The aim of the present study was to propose a new approach for 3D computed tomography (CT) airway evaluation-guided endobronchial blocker placement in pediatric patients, and to determine its efficiency in clinical application.
Methods:
A total of 127 pediatric patients aged 0.5-3 years who were scheduled for elective thoracic surgery using one-lung ventilation (OLV) were randomized into the bronchoscopy (BRO) group and the CT group. The degree of lung collapse, postoperative airway mucosal injury, pulmonary infection within 72 h after surgery, and hoarseness after tracheal extubation; duration of postoperative mechanical ventilation, intensive care unit (ICU) stay and hospitalization; success rate of first blocker positioning; and required time and repositioning for successful blocker placement were compared between the 2 groups.
Results:
The degree of lung collapse, postoperative airway mucosal injury, pulmonary infection within 72 h after surgery, and hoarseness after tracheal extubation; duration of postoperative mechanical ventilation, ICU stay and hospitalization; success rate of first blocker positioning; and required time and repositioning for successful blocker placement were similar between the 2 groups (all P>0.05).
Conclusions:
For pediatric patients undergoing surgery with OLV, preoperative 3D CT airway evaluation could be used to guide endobronchial blocker placement, with a blocking efficiency similar to that of BRO-guided blocker placement.
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