PDF(Pubmed)
Abstract：
BACKGROUND: Vertebral body tethering (VBT) requires a thoracoscopic approach to visualize the vertebral bodies. Lung collapse and re-expansion have the potential to cause acute lung injury, resulting in increased oxygen and ventilation requirements.
OBJECTIVE: We compared the intraoperative ventilator management, intra- and postoperative blood gas determinations, and hospital stay information between adolescents undergoing unilateral versus bilateral lung isolation for vertebral body tethering.
METHODS: A study cohort of 132 propensity-matched cases (66 unilateral and 66 bilateral) was derived from 351 consecutive VBT cases. Patient demographic information, case information, fluid administration, ventilatory settings data, blood gas parameters, and complete blood count and differential data were entered into a datasheet. Derived parameters included values calculated from the alveolar gas equation to develop an oxygen cascade and measures of inflammatory response. Chi-square was used for categorical data, and independent samples and t-tests were used for continuous data.
RESULTS: The double lung isolation group required higher peak inspiratory pressures (SL 29±5 vs. DL 31±5, p=0.026), resulting in higher tidal volume (SL 246±63 vs. DL 334±101, p<0.001) and tidal volume per kg (SL 5.6±1.4 vs. DL 6.9±2, p<0.001) as compared to the single lung group. The double lung group required a higher partial pressure of inspired and alveolar oxygen as well as a higher alveolar to arterial oxygen tension gradient (SL 417±126 vs. DL 485±96, p=0.001) to achieve optimal arterial oxygen tension. Patients with double lung isolation had similar intensive care lengths of stay but a longer hospital stay than single lung isolation patients.
CONCLUSIONS: Patients undergoing double lung isolation required greater ventilatory support and had more evidence of acute lung injury, as evidenced by a higher postoperative alveolar to arterial oxygen gradient; however, these healthy adolescents tolerated the procedure well and only differed in the hospital length of stay by a day.
OBJECTIVE: We compared the intraoperative ventilator management, intra- and postoperative blood gas determinations, and hospital stay information between adolescents undergoing unilateral versus bilateral lung isolation for vertebral body tethering.
METHODS: A study cohort of 132 propensity-matched cases (66 unilateral and 66 bilateral) was derived from 351 consecutive VBT cases. Patient demographic information, case information, fluid administration, ventilatory settings data, blood gas parameters, and complete blood count and differential data were entered into a datasheet. Derived parameters included values calculated from the alveolar gas equation to develop an oxygen cascade and measures of inflammatory response. Chi-square was used for categorical data, and independent samples and t-tests were used for continuous data.
RESULTS: The double lung isolation group required higher peak inspiratory pressures (SL 29±5 vs. DL 31±5, p=0.026), resulting in higher tidal volume (SL 246±63 vs. DL 334±101, p<0.001) and tidal volume per kg (SL 5.6±1.4 vs. DL 6.9±2, p<0.001) as compared to the single lung group. The double lung group required a higher partial pressure of inspired and alveolar oxygen as well as a higher alveolar to arterial oxygen tension gradient (SL 417±126 vs. DL 485±96, p=0.001) to achieve optimal arterial oxygen tension. Patients with double lung isolation had similar intensive care lengths of stay but a longer hospital stay than single lung isolation patients.
CONCLUSIONS: Patients undergoing double lung isolation required greater ventilatory support and had more evidence of acute lung injury, as evidenced by a higher postoperative alveolar to arterial oxygen gradient; however, these healthy adolescents tolerated the procedure well and only differed in the hospital length of stay by a day.
摘要：
背景：椎体束缚（VBT）需要胸腔镜方法来观察椎体。肺塌陷和再扩张有可能导致急性肺损伤，导致氧气和通风需求增加。
目的：我们比较了术中呼吸机管理，术中和术后血气测定，以及接受单侧和双侧肺隔离的青少年之间的住院时间信息。
方法：一项132例倾向匹配病例（66例单侧和66例双侧）的研究队列来自351例连续VBT病例。患者人口统计信息，案例信息,液体管理,通气设置数据，血气参数,全血细胞计数和差异数据输入数据表。得出的参数包括从肺泡气体方程计算的值，以发展氧气级联反应和炎症反应的量度。卡方用于分类数据，连续数据采用独立样本和t检验。
结果：双肺隔离组需要更高的峰值吸气压力（SL29±5vs.DL31±5,p=0.026),导致更高的潮气量(SL246±63vs.DL334±101，p<0.001）和潮气量每公斤（SL5.6±1.4与与单肺组相比，DL6.9±2，p<0.001）。双肺组需要较高的吸入和肺泡氧分压，以及较高的肺泡至动脉血氧张力梯度（SL417±126vs.DL485±96，p=0.001）以达到最佳的动脉血氧张力。双肺隔离患者的重症监护住院时间与单肺隔离患者相似，但住院时间更长。
结论：接受双肺隔离的患者需要更多的通气支持，并且有更多的急性肺损伤证据，如术后肺泡至动脉血氧梯度较高所证明的；然而，这些健康的青少年对该手术的耐受性很好，仅在住院时间上相差一天。
目的：我们比较了术中呼吸机管理，术中和术后血气测定，以及接受单侧和双侧肺隔离的青少年之间的住院时间信息。
方法：一项132例倾向匹配病例（66例单侧和66例双侧）的研究队列来自351例连续VBT病例。患者人口统计信息，案例信息,液体管理,通气设置数据，血气参数,全血细胞计数和差异数据输入数据表。得出的参数包括从肺泡气体方程计算的值，以发展氧气级联反应和炎症反应的量度。卡方用于分类数据，连续数据采用独立样本和t检验。
结果：双肺隔离组需要更高的峰值吸气压力（SL29±5vs.DL31±5,p=0.026),导致更高的潮气量(SL246±63vs.DL334±101，p<0.001）和潮气量每公斤（SL5.6±1.4与与单肺组相比，DL6.9±2，p<0.001）。双肺组需要较高的吸入和肺泡氧分压，以及较高的肺泡至动脉血氧张力梯度（SL417±126vs.DL485±96，p=0.001）以达到最佳的动脉血氧张力。双肺隔离患者的重症监护住院时间与单肺隔离患者相似，但住院时间更长。
结论：接受双肺隔离的患者需要更多的通气支持，并且有更多的急性肺损伤证据，如术后肺泡至动脉血氧梯度较高所证明的；然而，这些健康的青少年对该手术的耐受性很好，仅在住院时间上相差一天。
