Clinical application of transorotracheal tube tracheal insufflation of oxygen in patients undergoing simple video-assisted thoracoscopic surgery.

Abstract

Video-assisted thoracoscopic surgery (VATS) has been performed during ganglionectomy and bullectomy and usually requires a collapsed or immobilized lung. Transtracheal insufflation of oxygen (TRIO) maintains an immobilized lung, adequate oxygenation, and partial CO2 elimination but has never been used for VATS. We have simplified the TRIO design with a catheter inserted through the lumen of the orotracheal tube in what we call "transorotracheal tube TRIO" (TRIO-TOTT) and investigated its clinical use on simple VATS. Eleven patients undergoing bullectomy for primary simple pneumothorax (PSP) were studied. During the performance of VATS, a 12-gauge suction catheter was inserted as our modification and connected to the gas outlet of an anesthetic machine. The flow rate of oxygen was maintained at 10 L/min. Blood gas was collected prior to TRIO-TOTT, during TRIO-TOTT at 5, 10, 15, and 20 min, and 5 min after TRIO-TOTT. The blood gas data showed excellent oxygenation while the PaCO2 increased at a rate of 1.2 mm Hg/min compared to 3-4 mm Hg/min for apnea oxygenation. After 20 min, the mean +/- SEM PaO2 and PaCO2 were 428 +/- 27 and 65.0 +/- 2.6 mm Hg, respectively. We conclude that TRIO-TOTT is a simple, safe, and effective ventilation method for simple VATS.