Protecting the non-operative lobe/s of the operative lung can reduce the pneumonia incidence after thoracoscopic lobectomy: a randomised controlled trial

TL;DR

Using a double-bronchial blocker with CPAP during lung surgery can significantly reduce postoperative pneumonia in both the operative and non-operative lungs.

Contribution

A new technique using a double-bronchial blocker with CPAP to protect non-operative lobes during thoracoscopic lobectomy is shown to reduce pneumonia risk.

Findings

Group DBB had a significantly lower pneumonia incidence in the operative lung (27.5% vs 5%) on postoperative day 1.

Group DBB also showed reduced pneumonia in the non-operative lung (40% vs 15%) on postoperative day 1.

The DBB technique with CPAP is more effective than routine bronchial blocker use in preventing postoperative pneumonia.

Abstract

Lung isolation usually refers to the isolation of the operative from the non-operative lung without isolating the non-operative lobe(s) of the operative lung. We aimed to evaluate whether protecting the non-operative lobe of the operative lung using a double-bronchial blocker (DBB) with continuous positive airway pressure (CPAP) could reduce the incidence of postoperative pneumonia. Eighty patients were randomly divided into two groups (n = 40 each): the DBB with CPAP (Group DBB) and routine bronchial blocker (Group BB) groups. In Group DBB, a 7-Fr BB was placed in the middle bronchus of the right lung for right lung surgery and in the inferior lobar bronchus of the left lung for left lung surgery. Further, a 9-Fr BB was placed in the main bronchus of the operative lung. In Group BB, routine BB placement was performed on the main bronchus on the surgical side. The primary endpoint was the postoperative pneumonia incidence. Compared with Group BB, Group DBB had a significantly lower postoperative pneumonia incidence in the operative (27.5% vs 5%, P = 0.013) and non-operative lung (40% vs 15%) on postoperative day 1. Compared with routine BB use for thoracoscopic lobectomy, using the DBB technique to isolate the operative lobe from the non-operative lobe(s) of the operative lung and providing CPAP to the non-operative lobe(s) through a BB can reduce the incidence of postoperative pneumonia in the operative and non-operative lungs.

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