THRIVE and Non-intubated Thoracic Surgery
Lykilorð
Útdráttur
Lýsing
Lung cancer has been a leading cause of death for years. There are more than 10,000 new cases in Taiwan. Delayed discovery of the disease is a reason for high mortality rate. Most cases are discovered after second stage. Early discovery of the disease rely on low dose CT scans. Early stage lung cancer patients are candidates for minimally invasive surgeries. Traditionally thoracomies and video-assisted thoracic surgeries require general anesthesia with double lumen endobronchial tubes. The technique of double lumen intubation and one lung ventilation causes respiratory complications and damage to the trachea, larynx and vocal cords. With the development of single port thoracotomies, anesthesia can be minimized as well. Patients receive an epidural, intercostal or paravertebral nerve block to decrease pain. Minimal anesthetic agents may be given to decrease anxiety or to induce light sedation. Patients does not need to be intubated and can maintain respiratory function and can recover quickly.
Not only can video-assisted thoracic surgery be used in lung tumor treatment, it can also be used to threat esophageal and mediastinal lesions, pneumothorax or as a diagnostic tool. Video-assisted thoracic surgery was shown to decrease acute phase inflammatory reactions, decrease immunosuppression and can be beneficial for tumor treatment.
The intravenous sedation medications used in non-intubate thoracic surgery decrease pain and anxiety. However, many will develop respiratory depression and upper airway obstruction. Also, spontaneous pneumothorax during surgery causes one lung ventilation. Traditional oxygen supply cannot meet the demand of non-intubated thoracic surgery. Transnasal humidified rapid-insufflation ventilator exchange offers 30-70 L/min oxygen via nasal cannula. Its humidified oxygen can decrease discomfort from cold dry gas. It also provides positive pressure to the airway thus decrease airway obstruction.
Our hypothesis is that non-intubated thoracic surgery with transnasal humidified rapid-insufflation ventilator exchange can maintain optimal surgical condition such as maintain arterial oxygen pressure, decrease acute phase reactions, tumor suppression and accelerate recovery after surgery.
Dagsetningar
| Síðast staðfest: | 07/31/2017 |
| Fyrst lagt fram: | 09/04/2017 |
| Áætluð skráning lögð fram: | 09/05/2017 |
| Fyrst sent: | 09/06/2017 |
| Síðasta uppfærsla lögð fram: | 09/05/2017 |
| Síðasta uppfærsla sett upp: | 09/06/2017 |
| Raunverulegur upphafsdagur náms: | 09/10/2017 |
| Áætlaður aðallokunardagur: | 09/09/2018 |
| Áætlaður dagsetningu rannsóknar: | 09/09/2018 |
Ástand eða sjúkdómur
Íhlutun / meðferð
Device: THRIVE group
Stig
Armhópar
| Armur | Íhlutun / meðferð |
|---|---|
| THRIVE group Patients receiving non-intubated thoracic surgery for lung nodule resections using intravenous sedation and transnasal humidified rapid-insufflation ventilator exchange | Device: THRIVE group high flow nasal cannula with humidified oxygen |
| Double lumen group Patients receiving non-intubated thoracic surgery for lung nodule resections using general anesthesia and double lumen endobronchial tube |
Hæfniskröfur
| Aldur hæfur til náms | 20 Years Til 20 Years |
| Kyn sem eru hæf til náms | All |
| Sýnatökuaðferð | Non-Probability Sample |
| Tekur við heilbrigðum sjálfboðaliðum | Já |
| Viðmið | Inclusion Criteria: - Lung nodules requiring surgical resection - Resectable by video-assisted thoracic surgery Exclusion Criteria: - ASA class IV or V - Room air oxygen saturation by pulse oximeter < 90% - Emergent surgery - Use of inotropics or vasoconstrictors - History of nasal surgery or cranial surgery - Abnormal coagulation profile - History of spinal surgery or trauma |
Útkoma
Aðal niðurstöður ráðstafanir
1. Arterial oxygen pressure [From induction of anesthesia to surgical procedure to end of recovery room observation, duration of six hours.]
2. Arterial carbon dioxide pressure [From induction of anesthesia to surgical procedure to end of recovery room observation, duration of six hours.]
3. Duration of stay [From admission to ward to discharge from ward, duration of 5 days to two weeks.]
Aðgerðir vegna aukaatriða
1. Acute phase reaction [From induction of anesthesia to surgical procedure to fifth post-operative day, duration of six days.]
2. Interleukins [From induction of anesthesia to surgical procedure to fifth post-operative day, duration of six days.]
3. TNF [From induction of anesthesia to surgical procedure to fifth post-operative day, duration of six days.]
4. Immune cell count [From induction of anesthesia to surgical procedure to fifth post-operative day, duration of six days.]
