A Prospective, Ex Vivo Trial of Endobronchial Blockade Management Utilizing 3 Commonly Available Bronchial Blockers

Abstract

BACKGROUND: Lung isolation with bronchial blockers is a well-described and accepted procedure, often described for use during the management of massive hemoptysis. Recommendations for balloon inflation are sparse, with some advocating for saline whereas other suggest air, including the manufacturers. We sought to evaluate the optimal method for balloon inflation in an ex vivo trial. METHODS: We performed a prospective trial utilizing 3 commercially available bronchial blockers commonly described for use in lung isolation and massive hemoptysis management. We utilized the Arndt Endobronchial Blocker (Cook Medical), the Cohen Tip Deflecting Endobronchial Blocker (Cook Medical), and the Fogarty Venous Thrombectomy Catheter (Edwards LifeSciences). Balloon size and deflation assessment were tested within 3 different scenarios comparing air versus saline. Welch t test was performed to compare means between groups, and a generalized estimating equation model was utilized to compare balloon diameter over time to account for correlation among repeated measures from the same balloon. RESULTS: All 3 endobronchial blocker systems were observed in triplicate. During free-standing balloon inflation, all 3 endobronchial systems displayed a greater degree of balloon deflation over time with air as opposed to saline (P < .001). Within a stent-based model, inflation with air of all 3 endobronchial systems, according to manufacturer recommendations, demonstrated significantly decreased time until fluid transgression occurred when compared to a saline model (P < .001). Within a stent-based model, inflation with air, according to clinical judgment, demonstrated significantly decreased time until fluid transgression in the Arndt (P = .016) and the Fogarty (P < .001) system, but not the Cohen (P = .173) system, when compared with saline. CONCLUSIONS: The utilization of saline for balloon inflation during bronchial blockade allows for more consistent balloon inflation. The use of saline during balloon inflation appears to delay passive, spontaneous balloon deflation time when compared to air during a model of endobronchial blockade. The approach of saline inflation should be tested in humans to demonstrate the overall applicability and validity of the current findings.

A Tapered Cuff Tracheal Tube Decreases the Need for Cuff Pressure Adjustment After Surgical Retraction During Anterior Cervical Spine Surgery: A Randomized Controlled, Double-Blind Trial

“…It is also robust for non-normally distributed data in the event that the distribution of cuff pressure data were non-parametric (28)(29)(30). We also analyzed the time × treatment interaction by using the difference-in-differences regression method to examine the pre-post change in cuff pressure at each observed timepoint to delineate the effect of the group on surgical intervention Data are summarized as the median (IQR) and shown as the mean (standard error of mean) (31). Postoperative outcomes were compared between groups using GEE models.…”

“…Supplementary Table 2 shows the intraoperative cuff pressures. The median (IQR) cuff pressures (mm Hg) were significantly lower for the tapered cuff than for the control cuff after tracheal intubation [9 (7-12) vs. 11 (8)(9)(10)(11)(12)(13)(14); P = 0.009)], after neck extension [9 (7-12) vs. 12 (10-15); P < 0.001] and after retraction [18 (15-23) vs. 25 (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31); P = 0.007, Figure 3A]. Pressure differentials (i.e., pre-post change) caused by surgical retraction and pressure adjustment were smaller in the tapered group than in the control group (Figure 3D).…”

Challenge of Lung Isolation in Patients with Vocal Cord Implants

“…Endobronchial blockers placed via standard, singlelumen ETT can be an effective alternative to DLT for lung isolation and may help reduce airway trauma from OLV (17). The EBB was used as early as the 1970s, followed by multiple modifications made through the years (18). The older versions of EBB were also relatively "high-maintenance" devices because of the frequent dislodgment during surgery.…”

Current Practice Issues in Thoracic Anesthesia

“…Because BBs may be manipulated separately from the ET, their use eliminates the need to change the tube during the procedure, if large diameter flexible bronchoscopy is part of the procedure or if the patient requires postoperative ventilatory support. 43,44 The clinical scenarios in which BB can be used are shown in Figure 2.…”