![]() A Coopdech EB Tube (Daiken Medical Co., Ltd) was inserted to establish lung ventilation and to simulate endobronchial intubation. ![]() Depth of anesthesia was monitored and maintained the stable states between 40 to 60 with a Bispectral Index Monitor (BIS, Medtronic Co.) during the investigation and the operations. The patients were intubated using an 8-mm cuffed endotracheal tube fixed at 20 cm at the incisor level. General anesthesia was induced using a combination of 1–2 mcg/kg fentanyl, 0.2 mg of glycopyrrolate, 1–2 mg/kg propofol, and 0.2 mg/kg cisatracurium. All patients provided written informed consent the day before surgery to an investigator who was not involved in intraoperative care ( Figure 2).Īnesthesia, Intubation, and Lung Ventilation Patients with a history of lung surgery were excluded. Adult patients undergoing elective thoracoscopic surgery for lung tumor resection and using EBs for lung ventilation were recruited between September 2020 and May 2021. The study protocol was approved by the Research Ethics Committee of National Taiwan University Hospital and registered in the protocol registration system (NCT04507958). Method Patient RecruitmentĪ double-blind randomized controlled trial was conducted at a university hospital in Taipei, Taiwan. Through a double-blind randomized controlled trial, we compared the accuracy of electronic auscultation in full PPE and conventional auscultation performed without PPE to differentiate ventilation statuses during thoracic surgery. Therefore, selective lung ventilation may be appropriate for safely testing the suitability of electronic auscultation for the PPE protocol. Endobronchial blockers (EBs) can be used for this procedure and may simulate endobronchial intubation because asymmetric lung inflation is characteristic of both conditions ( Figure 1). Selective lung ventilation is mandatory for patients undergoing thoracic surgery, and it can be identified through conventional auscultation ( 4). However, this premise is difficult to investigate prospectively. For instance, electronic stethoscopes may provide adequate auscultation quality for practitioners complying with the PPE protocol because no earpiece is required and breath sounds can be transmitted through a speaker. Telemedicine technology may offer a potential solution. However, auscultation through conventional stethoscopy may breach the PPE protocol thus, clinicians may have to abandon this procedure, a common physical examination in critical care. In view of the ongoing COVID-19 pandemic, clinicians performing endotracheal intubation for patients with COVID-19 infection experiencing respiratory distress must wear personal protective equipment (PPE) to prevent infection transmission ( 1– 3). ![]() Users reported satisfactory experience with the electronic stethoscope.Ĭhest auscultation of bilateral breath sounds is the first step in detecting endotracheal tube malpositioning. In conclusion, electronic auscultation assessments of ventilation status as examined during thoracic surgery in full PPE were comparable in accuracy to corresponding conventional auscultation assessments made without PPE. Furthermore, the user experience questionnaire revealed that the majority of participant anesthesiologists (90.5%) rated the audio quality of electronic lung sounds as comparable or superior to that of conventional acoustic lung sounds. For detection of the true unilateral lung ventilation, the F1 score and the phi were 0.904 and 0.654, respectively for conventional auscultation were 0.919 and 0.706, respectively for electronic auscultation. Electronic auscultation revealed a positive predictive value of 87% (95% CI 77 to 93%), and a negative predictive value of 91% (95% CI 58 to 99%), comparable to the results for conventional auscultation. The rates of correct ventilation status detection were 86 and 88% in the conventional and electronic auscultation groups ( p = 1.00). Conventional and electronic auscultation was performed without and with full PPE, respectively, of 50 patients with selective lung ventilation. This double-blinded randomized controlled trial evaluated the feasibility of using ear-contactless electronic stethoscope to identify endobronchial blocker established selective lung ventilation, simulating endobronchial intubation during thoracic surgery with full PPE. Department of Anesthesiology, National Taiwan University Hospital, Taipei, TaiwanĬhest auscultation is the first procedure performed to detect endotracheal tube malpositioning but conventional stethoscopes do not conform to the personal protective equipment (PPE) protocol during the COVID-19 pandemic. ![]() Tzu-Jung Wei Ping-Yan Hsiung Jen-Hao Liu Tzu-Chun Lin Fang-Tzu Kuo Chun-Yu Wu *
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