Left-Sided Double-Lumen Tube vs EZ-Blocker for One-Lung Ventilation in Thoracic Surgery: A Systematic Review and Meta-Analysis

Abstract

Background. The EZ-Blocker is the newest generation of bronchial blocker and offers a potential alternative to left-sided double lumen tubes for lung isolation and one-lung ventilation during thoracic surgery. Methods. Databases were searched for randomized controlled trials comparing left-sided double lumen tube to the EZ-Blocker for one-lung ventilation during thoracic surgery. The time for placement, incidence of intraoperative displacement, and surgeons’ rating of lung collapse quality were designated as coprimary outcomes. The safety profiles of the two devices, including the incidence of airway trauma and post-extubation discomfort were also examined. Results. Six randomized controlled trials (495 patients) were analyzed. Compared to the EZ-Blocker, the left-sided double lumen tube was faster to place by a weighted mean difference of [95% CI] of −61.24 seconds [−102.48, −20.00] (P = .004) and was much less likely to become displaced during lung isolation with an odds ratio [95% CI] of .56 [.34, .91] (P = .02). The left-sided double lumen tube and the EZ-Blocker provided similar surgeon-rated quality of lung isolation. Although the left-sided double lumen tube caused a greater degree of post-extubation sore throat, there was a similar incidence of carinal trauma and post-extubation hoarseness compared to the EZ-Blocker. Conclusion. Our analysis suggests that the left-sided double lumen tube can be placed more quickly and is less prone to intraoperative displacement compared to the EZ-Blocker; the quality of lung collapse is similar. Thus, evidence appears to support the continued utilization of the left-sided double lumen tube for routine thoracic surgery requiring one-lung ventilation.

Embracing Scrutiny: The Importance of Critical Evaluation and Transparency in Research

“…Our second Original Research article is a demonstration of this, evaluating the existing literature comparing the Rüsch ® EZ-Blocker™ to the more traditional left-sided double lumen tube (L-DLT) for lung isolation in thoracic surgery. 7 In a systematic review and meta-analysis spanning 6 studies and 495 patients, Kumar and colleagues found that the L-DLT tube was faster to place by over a minute (mean difference À61.24 seconds; 95% CI À102.48 to À20.00; P = .004), a finding supported by previous work 8 demonstrating faster placement of L-DLTs as compared to a pooled group of all bronchial blockers. This analysis also found that L-DLTs were much less likely to be displaced during lung isolation with an odds ratio of .56 (95% CI .34 to .91; P = .02), though these advantages came at the cost of a greater degree of postextubation sore throat.…”

Protecting the non-operative lobe/s of the operative lung can reduce the pneumonia incidence after thoracoscopic lobectomy: a randomised controlled trial

“…Double-lumen tubes (DLT) and bronchial blockers (BB) are the most commonly used airway tools in thoracic surgery 1 . They allow isolation of the operative lung from the non-operative lung, which prevents contamination of the non-operative lung by pollutants, such as blood and sputum 2 . However, in thoracoscopic lobectomy, these two options only protect the non-operative lung from contamination and do not protect the non-operative lobe(s) of the operative lung.…”