Efficiency, Efficacy, and Safety of EZ-Blocker Compared with Left-sided Double-lumen Tube for One-lung Ventilation

Abstract

Background: Double-lumen tubes (DLTs) or bronchial blockers are commonly used for one-lung ventilation. DLTs are sometimes difficult or even impossible to introduce, and the incidence of postoperative hoarseness and airway injuries is higher. Bronchial blockers are more difficult to position and need more frequent intraoperative repositioning. The design of a Y-shaped bronchial blocker, the EZ-Blocker (Teleflex Life Sciences Ltd., Athlone, Ireland) (EZB), combines some advantages of both techniques. The objective of this study was to assess whether EZB performs clinically better than left-sided DLTs (Broncho-cath; Mallinckrodt, Athlone, Ireland) without causing more injury. Primary outcome was the frequency of initial malpositions. Methods: Eligible patients were adults scheduled for surgery requiring one-lung ventilation who met criteria for placement of both devices. In this parallel trial, 100 consecutive and blinded patients were assigned randomly using a computer-generated list to two groups. The incidence of malposition and ease and time of placement were recorded. Blinded assessors investigated quality of lung deflation, postoperative complaints, and damage to the airway.Results: Placement of a DLT was unsuccessful twice. The incidence of initial malposition was high and comparable between EZBs (37 of 50) and DLTs (42 of 49) (P = 0.212). Placing single-lumen tubes and EZBs took more time but was rated easier. Quality of lung deflation was comparable. Fewer patients in the EZB group complained of sore throat at day 1. There was a higher incidence of tracheal hematoma and redness and bronchial hematoma in the DLT group. Conclusions:The EZB is an efficient and effective device for one-lung ventilation and causes less injury and sore throat than a DLT.

Intubation with VivaSight or conventional left-sided double-lumen tubes: a randomized trial

“…The number of airway injuries in the conventional DLT group was similar to that reported by Mourisse et al 5 Results of our study suggest that minor airway injuries (e.g., tracheal redness, tracheal bleeding, carinal bleeding) tended to be more common in the VivaSight DLT group. This may result from the larger outer diameter of the VivaSight DLT.…”

“…An investigator, blinded to the group assignment, inserted a flexible bronchoscope via the laryngeal mask airway to search for bronchial or pharyngolaryngeal injuries using established criteria and scoring. 5 Patients were then extubated if clinically appropriate and transferred to the postanesthesia care unit (PACU) where they remained for at least two hours. The duration of intubation, defined as the time from insertion of the laryngoscope until extubation of the DLT, was documented.…”

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

“…[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. 6,8,11 There were some limitations to this study.…”

“…Indeed, prior publications have reported one period of apnea -i.e., prior to initiating OLV, and few have described the use of any apnea period prior to initiating OLV. [8][9][10] They showed similar or inferior results compared with using the DL-ETT. The results we obtained by adding a second apnea period at the time of pleural opening showed a decrease in time to obtain complete lung collapse and an important increase in the quality of lung deflation.…”

“…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.…”