Effect of Continuous Intra-airway Monitoring Under Visible Double-lumen Bronchial Catheter on Postoperative Complications of Lung Surgery

Study Overview
=================
Brief Summary
-----------------
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.

Official Title
-----------------
Effect of Continuous Intra-airway Monitoring Under Visible Double-lumen Bronchial Catheter on Postoperative Complications of Lung Surgery (a Prospective, Single-center, Randomized, Controlled Clinical Study)

Conditions
-----------------
Postoperative Pulmonary Complications

Intervention / Treatment
-----------------
* Procedure: Continuous intra-airway monitoring and intervention during surgey


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: 1. Age 18-80 years, BMI 18.5-28 kg/m2, male or female 2. Patients who are to undergo unilateral thoracoscopic resection of more than three lung segments or lobectomies 3. Patients who can be extubated with 35# and 37# double-lumen bronchial catheters after pre-anesthetic evaluation 4. Subjects voluntarily sign the informed consent form for this trial. 5. Patients or their caregivers are able to fill out the survey form and can correctly understand and cooperate with the postoperative rehabilitation instructions of the medical staff. 6. Patients have SPO2 ≥ 96% when inhaling air preoperatively Exclusion Criteria: 1. Patients with limited ability to cooperate with the study, such as the presence of cognitive dysfunction, mental illness, speech impairment or severe visual impairment or hearing impairment 2.ASA ≥IV 3. difficult airway, abnormal tracheal development, main airway stenosis, tumor, tracheoesophageal fistula 4. Complex sleeve pneumonectomy, unilateral total pneumonectomy, bilateral lung surgery 5. Preoperative anemia, Hb≤100g/L 6. Serum albumin ≤ 35g/L

Ages Eligible for Study
-----------------
Minimum Age: 18 Years
Maximum Age: 80 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Test group (group T)<br>lung isolation was performed with visual double-lumen bronchial catheter, andcontinuous airway monitoring and intervention were performed | Procedure: Continuous intra-airway monitoring and intervention during surgey<br>* 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<br>|
| No Intervention: Control group (group C)<br>lung isolation was performed with visual double-lumen bronchial catheter, and only intra-airway video was performed without monitoring | |

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | 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 Oral temperature > 38°C; White blood cell count > 11.2×10^12/L or use respiratory antibiotics (except prophylactic antibiotics); Pneumonia or pulmonary infection diagnosed by the treating doctor; Chest X-ray examination suggested atelectasis or consolidation; Purulent sputum (yellow/green) with characteristics different from those before operation; Sputum microbiological examination was positive; Oxygen saturation of finger pulse < 90% under suction condition; Readmission or ICU stay > 36h due to respiratory problems If 4 or more of the above 8 items are satisfied, the subject is considered to have developed pulmonary complications. | 3 days after operation | 

Secondary Outcome Measures

| Outcome Measure | 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：□ | 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 Number of intubation times:|__| Times Time taken for successful intubation positioning:|__|__| Minutes|__|__| seconds Whether fiber bronchoscopy is used for positioning: □ No □ Yes | during the operation | 
| Hypoxemia during operation | Intraoperative SPO2<90% □ Yes □ No st time:|__|__| Minutes|__|___| Seconds; nd time:|__|__| Minutes|__|___| Seconds; rd time:|__|__| Minutes|__|___| Seconds; | 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 video review: The suction rate during intraoperative sputum suction: □ 80%-100%； □ 50-80%; □ 0-50%; After tracheal extubation, take photos to compare the secretion at the end of the bronchus: None Yes: □ Small amount (secretions adhering to the wall less than 2cm); □ Moderate amount (secretion adhering to the wall 2-4cm); □ Large amount (secretions sticking to the wall exceeding 4cm) | Postoperative |