Comparison of a Modified Double-Lumen Endotracheal Tube with a Single-Lumen Tube with Enclosed Bronchial Blocker

Abstract

This study compared the modified BronchoCath double-lumen endotracheal tube with the Univent bronchial blocker to determine whether there were objective advantages of one over the other during anesthesia with one-lung ventilation (OLV). Forty patients having either thoracic or esophageal procedures were randomly assigned to one of two groups. Twenty patients received a left-side modified BronchoCath double-lumen tube (DLT), and 20 received a Univent tube with a bronchial blocker. The following were studied: 1) time required to position each tube until satisfactory placement was achieved; 2) number of times that the fiberoptic bronchoscope was required; 3) frequency of malpositions after initial placement with fiberoptic bronchoscopy; 4) time required until lung collapse; 5) surgical exposure ranked by surgeons blinded to type of tube used; and 6) cost of tubes per case. No differences were found in: 1) time required to position each tube (DLT 6.2 +/- 3.1 versus Univent 5.4 +/- 4.5 min [mean +/- SD]); 2) number of bronchoscopies per patient (DLT median 2, range 1-3 versus Univent median 3, range 2-5); or 3) time to lung collapse (DLT 7.1 +/- 5.4 versus Univent 12.3 +/- 10.5 min). The frequency of malposition was significantly lower for the DLT (5) compared to the Univent (15) (P < 0.003). Blinded evaluations by surgeons indicated that 18/20 DLT provided excellent exposure compared to 15/20 for the Univent group (P = not significant). We conclude that in spite of the greater frequency of malposition seen with the Univent, once position was corrected adequate surgical exposure was provided. In the Univent group the incidence of malposition and cost involved were both sufficiently greater that we cannot find cost/ efficacy justification for routine use of this device.

Bronchial blocker versus left double-lumen endotracheal tube in video-assisted thoracoscopic surgery: a randomized-controlled trial examining time and quality of lung deflation

“…Campos et al used suction in more than 50% of lung isolation cases when using the BB and frequently when using the left-sided DL-ETT. [4][5][6] Suction was frequently used in more than 50% of the published studies, only two studies did not use it in their protocol. 8,10 Deliberately occluding the internal channel of the BB (small diameter, 2 mm; effective length, 67 cm), allows extrapolation of the results to every commercially available BB and confirms our impression that this channel does not participate passively in lung deflation.…”

“…[4][5][6][7][8] Fig. 1 outlines the standardized definition of lung collapse on a three-point visual and descriptive scale, where 1 = no lung collapse; 2 = partial lung collapse; and 3 = total lung collapse.…”

“…2,3 Nevertheless, previous studies comparing lung deflation using either a DL-ETT or BB have provided conflicting results. [4][5][6][7][8][9][10][11][12][13] Moreover, the majority of these studies had significant limitations. For example, some studies included open thoracotomies along with VATS; other studies used subjective and not standardized criteria to evaluate the quality of lung collapse, and few studies reported time to ''complete'' lung collapse.…”

“…For example, some studies included open thoracotomies along with VATS; other studies used subjective and not standardized criteria to evaluate the quality of lung collapse, and few studies reported time to ''complete'' lung collapse. 4,6 Furthermore, the efficacy of BB for lung deflation might be manufacturer/model specific as their internal BB channels, which allow for the egress of air, have different diameters. 8,11 A recent systematic review and meta-analysis comparing the efficacy and adverse effects of DL-ETTs vs BBs identified 22 papers on the subject, though only nine papers with relevant data were analyzed.…”

One Lung Ventilation in a Case Performed Mitral Valve Replacement with Right Thoracotomy

“…(6) Campos (7) TAV için kullandıkları "Univent" bronşiyal blokerin yerleşiminin sık bozulduğu ve olgunun pozisyon değişikliklerinden sonra fiberoptik bronkoskopi ile bloker yerleşiminin doğrulanmasının zorunlu olduğu sonucuna varmıştır. Çünkü çift lümenli tüplerin ve blokerlerin yanlış yerleşimi kör entü-basyonda olduğu kadar hastaya pozisyon verilirken de olmaktadır.…”