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Journal of Ultrasound

, Volume 16, Issue 4, pp 195–199 | Cite as

Thoracic ultrasound confirmation of correct lung exclusion before one-lung ventilation during thoracic surgery

  • Andrea SaporitoEmail author
  • Antonio Lo Piccolo
  • Daniele Franceschini
  • Renato Tomasetti
  • Luciano Anselmi
Original Article

Abstract

Introduction

Fiberoptic bronchoscopy is the standard method for verifying the correct position of a double-lumen endotracheal tube (DLET) prior to one-lung ventilation. However, it must be performed by a specially trained anesthesiologist and is often resource consuming. The aim of this study was to compare this approach with thoracic ultrasound done by a nurse anesthetist in terms of sensitivity, specificity, and cost-effectiveness.

Methods

We conducted a prospective cross-over case–control study involving 51 adult patients consecutively undergoing thoracic surgery with one-lung ventilation. After orotracheal intubation with a DLET, correct exclusion of the lung being operated on exclusion was assessed first by a certified anesthesiologist using standard fiberoptic bronchoscopy and then by a trained nurse anesthetist using thoracic ultrasound. The nurse was blinded as to the findings of the anesthesiologist’s examination.

Results

The two approaches proved to be equally sensitive and specific, but the ultrasound examination was more rapid. This factor, together with the fact that ultrasound was performed by a nurse instead of a physician, and the costs of materials and sterilization, had a significant economic impact amounting to a net saving of €37.20 ± 5.40 per case.

Conclusions

Although fiberoptic bronchoscopy is still the gold standard for checking the position of a DLET, thoracic ultrasound is a specific, sensitive, cost-effective alternative, which can be used to rapidly verify the proper function of the tube based on the demonstration of correct lung exclusion.

Keywords

Thoracic ultrasound Anesthesia Thoracic surgery 

Riassunto

Introduzione

La fibrobroncoscopia è attualmente la tecnica di scelta per la verifica di un corretto posizionamento del tubo endotracheale a doppio lume, prima dell’esclusione polmonare necessaria alla ventilazione monopolmonare. Tale tecnica richiede tuttavia un medico anestesista specialista adeguatamente formato ed è dunque spesso costosa. Scopo dello studio è di compararla all’ecografia toracica effettuata da infermieri anestesisti, in termini di sensibilità, specificità e costo-efficacia.

Metodi

Abbiamo dunque realizzato uno studio caso-controllo, cross-over, in effettuata da un infermiere anestesista specificamente formato.una coorte continua di pazienti adulti sottoposti a chirurgia toracica in ventilazione monopolmonare. Dopo intubazione oro-tracheale con tubo doppio lume, ciascun paziente è stato sottoposto dapprima a controllo fibrobroncoscopico effettuato da un medico anestesista e successivamente ad ecografia toracica effettuata da un infermiere anestesista specificamente formato per determinare una corretta esclusione del polmone operato. L’infermiere non era a conoscenza dei risultati del controllo fibrocroncoscopico.

Risultati

Le due tecniche sono risultate comparabili in termini di sensibilità e specificità. L’ecografia toracica è risultata una tecnica significativamente più rapida da eseguire rispetto alla fibrobroncoscopia. Il tempo di esecuzione, unitamente al fatto che l’ecografia è stata eseguita da un infermiere, al costo del materiale nonché della sua sterilizzazione, hanno determinato un impatto economico significativo, con un risparmio netto di €37.20 ± 5.40 per caso trattato con ecografia toracica.

Conclusioni

Sebbene la fibrobroncoscopia rimanga il gold standard per il controllo e l’ottimizzazione del posizionamento del tubo endotracheale a doppio lume, l’ecografia toracica è una metodica sensibile, specifica e costo-efficace per valutarne rapidamente il corretto funzionamento, attraverso la verifica di una corretta esclusione polmonare.

Notes

Conflict of interest

The authors, Andrea Saporito, Antonio Lo Piccolo, Daniele Franceschini, Renato Tomasetti, and Luciano Anselmi declare that they have no conflicts of interest relative to this article.

Informed consent

All of the procedures performed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 [5]. All patients provided written informed consent to enrollment in the study and to the inclusion in this article of information that could potentially lead to their identification.

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Copyright information

© Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB) 2013

Authors and Affiliations

  • Andrea Saporito
    • 1
    Email author
  • Antonio Lo Piccolo
    • 1
  • Daniele Franceschini
    • 1
  • Renato Tomasetti
    • 1
  • Luciano Anselmi
    • 1
  1. 1.Anesthesia ServiceBellinzona Regional HospitalBellinzonaSwitzerland

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