• Rong Huang, Neng Wang, Xiaoming Lin, Yun Xia, Thomas J Papadimos, Quanguang Wang, and Fangfang Xia.
• Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China.
• J. Cardiothorac. Vasc. Anesth. 2024 Feb 1; 38 (2): 475481475-481.

ObjectivesTo assess when and whether clamping the double-lumen endobronchial tube (DLT) limb of the non-ventilated lung is more conducive to a rapid and effective lung deflation than simply allowing the open limb of the DLT to communicate with the atmosphere.DesignThis was a single-center, single-blind, randomized, controlled trial.SettingThe trial was performed in a single institutional setting.ParticipantsThe participants were 60 patients undergoing elective video-assisted thoracoscopic surgery.InterventionsPatients were randomized to the open-clamp airway technique (OCAT group) or control group. Patients in the control group had one-lung ventilation initiated upon being placed in the lateral decubitus position. The OCAT group had two-lung ventilation maintained until the pleural cavity was opened with the introduction of a planned thoracoscopic access port to allow the operated lung to fall away from the chest wall. Thereafter, ventilation was suspended (temporarily ceased) for 1 minute before the DLT lumen of the isolated lung was clamped. The primary outcome of the trial was the time to complete lung collapse scored as determined from video clips taken during surgery. The secondary outcomes were (1) lung collapse score at 30 minutes after pleural incision, (2) surgeon satisfaction with surgery, and (3) intraoperative hypoxemia.Measurements And Main ResultsThe median time to reach complete lung collapse in the OCAT group was 10 minutes (odds ratio 10.0, 95% CI 6.3-13.7), which was much shorter than that of the control group (25 minutes [odds ratio 25.0, 95% CI 13.6-36.4]). The difference in complete lung collapse at 30 minutes between the 2 groups was significant (p < 0.001). The surgeon's satisfaction with surgery was higher in the OCAT group than in the control group (8.5 ± 0.2 vs 6.8 ± 0.2; p < 0.001). There was no difference regarding intraoperative hypoxemia.ConclusionsSuspending ventilation of both DLT limbs for 1 minute after pleural cavity opening and then clamping the DLT lumen of the isolated lung resulted in a more rapid deflation of the surgical lung. This open-clamp airway technique is an effective technique for rapid surgical lung collapse during thoracoscopic surgery.Copyright © 2023 Elsevier Inc. All rights reserved.

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