Thumbnail Image
Item

A Comparative Evaluation of Unilateral and Bilateral Sequential Lung Isolation for Vertebral Body Tethering: A Retrospective Propensity Matched Analysis

Brenn, B. Randall
; 
Disilvio, Gregory M.
; 
Yarnall, Evan
; 
Steindler, Jessica
; 
Tarazi, Suhail
; 
Rompala, Alexander
; 
Akhnoukh, Kyrillos
; 
Choudhry, Dinesh K.
Citations
Altmetric:
Genre
Journal article
Date
2024-05-06
Advisor
Committee member
Group
Temple University. Hospital
Department
Subject
Acute lung injury
 Adolescent
 Lung isolation
 Scoliosis
 Vertebral body tethering
Permanent link to this record
https://scholarshare.temple.edu/handle/20.500.12613/12083
Collections
Faculty/Researcher Works
Show all metadata
Files
Thumbnail Image
Steindler-JournalArticle-2024-05.pdf
Adobe PDF, 223.79 KB
Research Projects
Organizational Units
Journal Issue
DOI
https://doi.org/10.7759/cureus.59723
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. Aims: 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. Conclusion: 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.
Description
Citation
Brenn B, Disilvio G M, Yarnall E, et al. (May 06, 2024) A Comparative Evaluation of Unilateral and Bilateral Sequential Lung Isolation for Vertebral Body Tethering: A Retrospective Propensity Matched Analysis. Cureus 16(5): e59723. doi:10.7759/cureus.59723
Citation to related work
Springer Science and Business Media
Has part
Cureus, Vol. 16, Iss. 5
ADA compliance
Embedded videos
License
Attribution CC BY
cb