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Liu Y, Liang L, Yang H. Airway management in "tubeless" spontaneous-ventilation video-assisted thoracoscopic tracheal surgery: a retrospective observational case series study. J Cardiothorac Surg 2023; 18:59. [PMID: 36737801 PMCID: PMC9898933 DOI: 10.1186/s13019-023-02157-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/24/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Surgeon and anesthetist share the airway in a simpler way in the resection and reconstruction phase of tracheal surgery in tubeless spontaneous-ventilation video-assisted thoracoscopic surgery (SV-VATS). Tubeless SV-VATS means stable spontaneous ventilation in the resection and reconstruction phase to anesthesiologist, and unobstructed surgical field to surgeon. What's the ideal airway management strategy during "Visual Field tubeless" SV-VATS for tracheal surgery is still an open question in the field. METHODS We retrospectively reviewed 33 patients without sleeve and carina resections during the study period (2018-2020) in our hospital. The initial management strategy for these patients was spontaneous ventilation for intrathoracic tracheal resection and reconstruction. We obtained and reviewed medical records from our institution's clinical medical records system to evaluate the airway management strategy and device failure rate for tracheal resection in Tubeless SV-VATS. RESULTS Between 2018 and 2020, SV-VATS was first attempted in the 33 patients who had intrathoracic tracheal surgery but without sleeve and carina resections. All patients underwent bronchoscopy (33/33) and 8 patients (8/33) received partial resection before surgery. During the surgery, the airway device comprised either a ProSeal laryngeal mask airway (ProSeal LMA) (n = 27) or single lumen endotracheal tube (n = 6). During the resection and reconstruction phase, Visual Field tubeless SV-VATS failed in 9 patients, and breathing support switched to plan B which is traditional ventilation of a single lumen endotracheal tube for cross field intubation (n = 4) and ProSeal LMA alongside a high-frequency catheter (high-frequency jet ventilation, HFJV) (n = 5) into the distal trachea ventilation. Preoperative respiratory failure or other ventilation-related complications were not observed in this cohort. CONCLUSION Base on current analysis either ProSeal LMA or endotracheal tube is an effective airway management strategy for tubeless SV-VATS with appropriate patient selection. It also provides breathing support conversion option when there's inadequate ventilation.
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Affiliation(s)
- Yuying Liu
- grid.470124.4Department of Anesthesia, The First Affiliated Hospital of Guangzhou Medical University, No. 151 Yanjiang Rd, Guangzhou, 510120 China
| | - Lixia Liang
- grid.470124.4Department of Anesthesia, The First Affiliated Hospital of Guangzhou Medical University, No. 151 Yanjiang Rd, Guangzhou, 510120 China
| | - Hanyu Yang
- Department of Anesthesia, The First Affiliated Hospital of Guangzhou Medical University, No. 151 Yanjiang Rd, Guangzhou, 510120, China.
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A Reverse Thymic Fat Pad Flap to Cover the Anastomosis of an Extended Tracheal Resection Following Induction Chemotherapy: A Challenging Case Report. SURGERIES 2022. [DOI: 10.3390/surgeries3030029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Extended tracheal resection after neoadjuvant chemotherapy is rarely described in patients with tracheal cancer. Controversies still exist among surgeons about the length of tracheal resectability and possible harmful anastomotic complications. Different vascularized tissue flaps can be used to protect the anastomotic suture line. We reported a 67-year-old patient with middle tracheal squamous cell carcinoma treated by induction chemotherapy followed by a successful extended tracheal resection. The anastomosis was covered by a reversed thymic fat pad flap to prevent the erosion of adjacent brachiocephalic vessels. Postoperative concurrent chemoradiation did not threaten the integrity of the suture line. Careful tracheal dissection and accurate release manoeuvres are mandatory to achieve a tension-limited anastomosis. Extended tracheal resection may be safely performed after induction chemotherapy, with excellent long-term outcomes. A thymic fat flap seems to be beneficial to suture-line healing.
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Pořízka M, Michálek P, Votruba J, Abdelmalak BB. Extracorporeal Oxygenation Techniques in Adult Critical Airway Obstruction: A Review. Prague Med Rep 2021; 122:61-72. [PMID: 34137682 DOI: 10.14712/23362936.2021.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Extracorporeal life support has been increasingly utilized in different clinical settings to manage either critical respiratory or heart failure. Complex airway surgery with significant or even total perioperative airway obstruction represents an indication for this technique to prevent/overcome a critical period of severe hypoxaemia, hypoventilation, and/or apnea. This review summarizes the current published scientific evidence on the utility of extracorporeal respiratory support in airway obstruction associated with hypoxaemia, describes the available methods, their clinical indications, and possible limitations. Extracorporeal membrane oxygenation using veno-arterial or veno-venous mode is most commonly employed in such scenarios caused by endoluminal, external, or combined obstruction of the trachea and main bronchi.
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Affiliation(s)
- Michal Pořízka
- Department of Anesthesiology and Intensive Care Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.
| | - Pavel Michálek
- Department of Anaesthesia, Antrim Area Hospital, Antrim, United Kingdom.,Department of Anesthesiology and Intensive Care Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Jiří Votruba
- 1st Department of Tuberculosis and Respiratory Diseases, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Basem B Abdelmalak
- Departments of General Anesthesiology and Outcomes Research, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, USA
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Suk P, Šrámek V, Čundrle I. Extracorporeal Membrane Oxygenation Use in Thoracic Surgery. MEMBRANES 2021; 11:membranes11060416. [PMID: 34072713 PMCID: PMC8227574 DOI: 10.3390/membranes11060416] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/26/2021] [Accepted: 05/26/2021] [Indexed: 12/19/2022]
Abstract
This narrative review is focused on the application of extracorporeal membrane oxygenation (ECMO) in thoracic surgery, exclusive of lung transplantation. Although the use of ECMO in this indication is still rare, it allows surgery to be performed in patients where conventional ventilation is not feasible-especially in single lung patients, sleeve lobectomy or pneumonectomy and tracheal or carinal reconstructions. Comparisons with other techniques, various ECMO configurations, the management of anticoagulation, anesthesia, hypoxemia during surgery and the use of ECMO in case of postoperative respiratory failure are reviewed and supported by two cases of perioperative ECMO use, and an overview of published case series.
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Affiliation(s)
- Pavel Suk
- International Clinical Research Center, St. Anne’s University Hospital Brno, 65691 Brno, Czech Republic
- Department of Anesthesiology and Intensive Care, St. Anne’s University Hospital Brno, 65691 Brno, Czech Republic;
- Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic
- Correspondence: (P.S.); (I.Č.J.)
| | - Vladimír Šrámek
- Department of Anesthesiology and Intensive Care, St. Anne’s University Hospital Brno, 65691 Brno, Czech Republic;
- Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic
| | - Ivan Čundrle
- International Clinical Research Center, St. Anne’s University Hospital Brno, 65691 Brno, Czech Republic
- Department of Anesthesiology and Intensive Care, St. Anne’s University Hospital Brno, 65691 Brno, Czech Republic;
- Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic
- Correspondence: (P.S.); (I.Č.J.)
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Mazzella A, Bertolaccini L, Petrella F, Spaggiari L. Veno-venous extra-corporeal membrane oxygenation-assisted right tracheal-sleeve pneumonectomy. Interact Cardiovasc Thorac Surg 2021; 33:649-651. [PMID: 33993258 DOI: 10.1093/icvts/ivab124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/22/2021] [Accepted: 03/31/2021] [Indexed: 11/13/2022] Open
Abstract
Tracheal sleeve pneumonectomy for lung cancer is an old technique, and it is reserved for exceptional cases with tracheal carina involvement. Intra-operative airways management of this operation is incredibly complex, involving thoracic surgeons, anaesthesiologists and pulmonologists. We report a case of a 38-year-old male with no clinical history, referred to our department for an adenoid-cystic carcinoma involving distal trachea, carina and main right bronchus. Tracheal sleeve pneumonectomy was performed using extra-corporeal membrane oxygenation (ECMO). A veno-venous ECMO circuit was established through a heparin-coated percutaneous cannula in the right femoral vein and a heparin-coated percutaneous cannula in the internal right jugular vein by ultrasound assistance. No major complications occurred, and the patient was discharged after 30-day bronchoscopic control, showing the absence of fistula and negativity of the methylene blue test. ECMO-assisted surgery ensures adequate respiratory support, haemodynamic stability, lower risk of bleeding complications with a clean operating field and better brain and myocardial oxygenation.
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Affiliation(s)
- Antonio Mazzella
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Luca Bertolaccini
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Francesco Petrella
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Spaggiari L, Sedda G, Petrella F, Venturino M, Rossi F, Guarize J, Galetta D, Casiraghi M, Iacono GL, Bertolaccini L, Alamanni F. Preliminary Results of Extracorporeal Membrane Oxygenation Assisted Tracheal Sleeve Pneumonectomy for Cancer. Thorac Cardiovasc Surg 2020; 69:240-245. [PMID: 32814351 DOI: 10.1055/s-0040-1714071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Tracheal sleeve pneumonectomy is a challenge in lung cancer management and in achieving long-term oncological results. In November 2018, we started a prospective study on the role of extracorporeal membrane oxygenation (ECMO) in tracheal sleeve pneumonectomy. We aim to present our preliminary results. METHODS From November 2018 to November 2019, six patients (three men and three women; median age: 61 years) were eligible for tracheal sleeve pneumonectomy for lung cancer employing the veno-venous ECMO during tracheobronchial anastomosis. RESULTS Only in one patient, an intrapericardial pneumonectomy without ECMO support was performed, but cannulas were maintained during surgery. The median length of surgery was 201 minutes (range: 162-292 minutes), and the average duration of the apneic phase was 38 minutes (range: 31-45 minutes). No complications correlated to the positioning of the cannulas were recorded. There was only one major postoperative complication (hemothorax). At the time of follow-up, all patients were alive; one patient alive with bone metastasis was being treated with radiotherapy. CONCLUSION ECMO-assisted oncological surgery was rarely described, and its advantages include hemodynamic stability with low bleeding complications and a clean operating field. As suggested by our preliminary data, ECMO-assisted could be a useful alternative strategy in select lung cancer patients.
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Affiliation(s)
- Lorenzo Spaggiari
- Department of Thoracic Surgery, IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy
| | - Giulia Sedda
- Department of Thoracic Surgery, IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Francesco Petrella
- Department of Thoracic Surgery, IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy
| | - Marco Venturino
- Department of Anesthesiology, IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Fabiana Rossi
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino IRCCS, Milano, Italy
| | - Juliana Guarize
- Department of Thoracic Surgery, IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Domenico Galetta
- Department of Thoracic Surgery, IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Monica Casiraghi
- Department of Thoracic Surgery, IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Giorgio Lo Iacono
- Department of Thoracic Surgery, IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Luca Bertolaccini
- Department of Thoracic Surgery, IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Francesco Alamanni
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino IRCCS, Milano, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy
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Ju Z, Ma J, Wang C, Yu J, Qiao Y, Hei F. Effects of pumpless extracorporeal lung assist on hemodynamics, gas exchange and inflammatory cascade response during experimental lung injury. Exp Ther Med 2018; 15:1950-1958. [PMID: 29434789 PMCID: PMC5776660 DOI: 10.3892/etm.2017.5656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 08/14/2017] [Indexed: 11/12/2022] Open
Abstract
Pumpless extracorporeal lung assist (pECLA) has been reported to efficiently remove the systemic CO2 production and provide mild to moderate oxygenation, thereby allowing for ventilator settings and modes prioritizing oxygenation and lung protection. However, an adequate bypass flow, the capacity to provide respiratory support and the effect on the inflammatory cascade response and tissue perfusion require further study to be determined. After induction of acute lung injury (ALI) by oleic acid injection, pECLA was implemented in 12 anaesthetized and mechanically ventilated dogs for 48 h. Improved oxygenation [partial oxygen pressure (PaO2) and oxygen saturation (SaO2) was measured by arterial blood gas analysis, and increased by 29 and 18%, respectively] and CO2 elimination (partial CO2 pressure decreased by 43.35%) were obtained after pECLA implementation. A maximum arterio-venous shunt flow of up to 25% of the foundational CO resulted in stable hemodynamics. The pECLA procedure did not elicit any further increase in the concentration of tumor necrosis factor-α, interleukin (IL)-6, IL-8 and endothelin-1 compared with that in the group subjected to oleic acid injection only. In addition, the pECLA procedure had no effect on lactate levels and urine production. In conclusion, pECLA is an efficient and promising strategy for providing a mild to moderate oxygenation and adequate decarboxylation, while avoiding excessive inflammatory cascade response and tissue hypoperfusion in an experimental ALI model.
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Affiliation(s)
- Zhihai Ju
- Extracorporeal Circulation Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, P.R. China
| | - Jinhui Ma
- Extracorporeal Circulation Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, P.R. China
| | - Chen Wang
- Department of Anesthesiology, Beijing Chaoyang Hospital, Beijing 100020, P.R. China
| | - Jie Yu
- Extracorporeal Circulation Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, P.R. China
| | - Yeru Qiao
- Extracorporeal Circulation Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, P.R. China
| | - Feilong Hei
- Extracorporeal Circulation Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, P.R. China
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Bazarov DV, Belov YV, Charchyan ER, Lokshin LS, Akselrod BA, Eremenko AA, Grigorchuk AY, Volkov AA. [Cardiopulmonary bypass in thoracic surgery]. Khirurgiia (Mosk) 2017:31-43. [PMID: 29076480 DOI: 10.17116/hirurgia20171031-43] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM To analyze advisability of cardiopulmonary bypass in thoracic surgery. MATERIAL AND METHODS We estimated early and long-term results of CPB-assisted thoracic interventions in 31 patients with malignant and benign thoracic diseases and invasion into vital mediastinal structures or with concomitant cardiovascular pathology. RESULTS Acceptable rates of mortality and morbidity confirm safety of CPB in thoracic surgery while satisfactory long-term outcomes are arguments in favor of this direction of thoracic oncology.
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Affiliation(s)
- D V Bazarov
- Petrovsky Russian Research Center of Surgery, Moscow, Russia
| | - Yu V Belov
- Petrovsky Russian Research Center of Surgery, Moscow, Russia; Chair of Hospital Surgery of Sechenov First Moscow State Medical University of Healthcare Ministry of the Russian Federation, Moscow, Russia
| | - E R Charchyan
- Petrovsky Russian Research Center of Surgery, Moscow, Russia
| | - L S Lokshin
- Petrovsky Russian Research Center of Surgery, Moscow, Russia
| | - B A Akselrod
- Petrovsky Russian Research Center of Surgery, Moscow, Russia
| | - A A Eremenko
- Petrovsky Russian Research Center of Surgery, Moscow, Russia
| | - A Yu Grigorchuk
- Petrovsky Russian Research Center of Surgery, Moscow, Russia
| | - A A Volkov
- Petrovsky Russian Research Center of Surgery, Moscow, Russia
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Schieren M, Böhmer A, Dusse F, Koryllos A, Wappler F, Defosse J. New Approaches to Airway Management in Tracheal Resections-A Systematic Review and Meta-analysis. J Cardiothorac Vasc Anesth 2017; 31:1351-1358. [PMID: 28800992 DOI: 10.1053/j.jvca.2017.03.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Although endotracheal intubation, surgical crossfield intubation, and jet ventilation are standard techniques for airway management in tracheal resections, there are also reports of new approaches, ranging from regional anesthesia to extracorporeal support. The objective was to outline the entire spectrum of new airway techniques. DESIGN The literature databases PubMed/Medline and the Cochrane Library were searched systematically for prospective and retrospective trials as well as case reports on tracheal resections. SETTING No restrictions applied to hospital types or settings. PARTICIPANTS Adult patients undergoing surgical resections of noncongenital tracheal stenoses with end-to-end anastomoses. INTERVENTIONS Airway management techniques were divided into conventional and new approaches and analyzed regarding their potential risks and benefits. MEASUREMENTS AND MAIN RESULTS A total of 59 publications (n = 797 patients) were included. The majority of publications (71.2%) describe conventional airway techniques. Endotracheal tube placement after induction of general anesthesia and surgical crossfield intubation after incision of the trachea were used most frequently without major complications. A total of 7 new approaches were identified, including 4 different regional anesthetic techniques (25 cases), supraglottic airways (4 cases), and new forms of extracorporeal support (25 cases). Overall failure rates of new techniques were low (1.8%). Details on patient selection and procedural specifics are provided. CONCLUSIONS New approaches have several theoretical benefits, yet further research is required to establish criteria for patient selection and evaluate procedural safety. Given the low level of evidence, it currently is impossible to compare methods of airway management regarding outcome-related risks and benefits.
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Affiliation(s)
- Mark Schieren
- Department of Anesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany.
| | - Andreas Böhmer
- Department of Anesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
| | - Fabian Dusse
- Department of Anesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
| | - Aris Koryllos
- Department of Thoracic Surgery, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
| | - Frank Wappler
- Department of Anesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
| | - Jerome Defosse
- Department of Anesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
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Pinelli F, Romagnoli S, Bevilacqua S, Macchiarini P. Extracorporeal Membrane Oxygenation-Assisted Esophagectomy. J Cardiothorac Vasc Anesth 2015; 29:436-8. [DOI: 10.1053/j.jvca.2014.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Indexed: 11/11/2022]
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First Experience With a New Miniaturized Pump-Driven Venovenous Extracorporeal CO2 Removal System (iLA Activve). ASAIO J 2014; 60:342-7. [DOI: 10.1097/mat.0000000000000073] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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