Pro: Bronchial Blockers Should Be Used Routinely for Providing One-Lung Ventilation

Neustein, Steven M.

doi:10.1053/j.jvca.2014.07.028

Cited by 33 publications

(18 citation statements)

References 13 publications

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“…▪ Kliniken, die regelhaft Ein-Lungen-Ventilationen durchführen, sollten einen dedizierten Bronchusblocker vorhalten. Seine indikationsgerechte Anwendung durch erfahrene Anästhesisten verbessert die Patientensicherheit, ohne dass Nachteile hinsichtlich verlängerter Anlagedauer, erhöhter Dislokationsraten oder verschlechterter chirurgischer Exposition zu befürchten sind [30].…”

Section: Atemwegsverletzungenunclassified

Atemwegsmanagement in der Thoraxanästhesie mit dem Bronchusblocker

Kreft¹,

Hachenberg²

2018

Anästhesiol Intensivmed Notfallmed Schmerzther

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Traditionally the double-lumen-tube (DLT) is considered the gold standard for lung separation. Despite being equally feasible for standard situations, there are special populations and circumstances requiring the use of a bronchial blocker (BB) to establish one-lung ventilation. Children under 8 years of age and patients without a patent orotracheal airway necessitate the use of a bronchial blocker in most cases, as well as those requiring selective lobar blockade or a rapid sequence induction. Surgery with predicted postoperative mechanical ventilation or in tracheotomized patients at least favors their use by avoiding the complications of a tube exchange. Bronchial blocker models currently in clinical use include the wire-guided Arndt-Blocker, the Flexitip Cohen-Blocker, the Fuji Uniblocker, the Y-shaped EZ-Blocker and the tracheoscopy-guided VivaSight-EB. Their common concept is the occlusion of the operative lung by the inflation of their distal balloon, with the deflation of that lung occurring through their inner lumen. They mainly differ in their mode of placement. Bronchial blockers offer a clinical performance comparable to the DLT. Placement times for lung isolation devices and surgical exposure may depend more on the experience of the anaesthetist than the device itself. Bronchial blockers won't replace the DLT as gold standard at least due to their cost of acquisition, but provided adequate training outside of the emergency situation, their utilisation offers equal operative conditions at comparable placement times, dislocation rates and ease of use. A modern bronchial blocker should be available in institutions managing complex thoracic cases.

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Section: Atemwegsverletzungenunclassified

Atemwegsmanagement in der Thoraxanästhesie mit dem Bronchusblocker

Kreft¹,

Hachenberg²

2018

Anästhesiol Intensivmed Notfallmed Schmerzther

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“…Double-lumen endotracheal tubes (DL-ETT) have generally been considered the gold standard for lung isolation and are considered by many to offer more rapid and better quality lung collapse when compared with bronchial blockers (BB). 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.…”

Section: Résumémentioning

confidence: 99%

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

Bussières

Somma

Castillo

et al. 2016

Can J Anesth/J Can Anesth

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Bronchial blocker versus left double-lumen endotracheal tube in video-assisted thoracoscopic surgery: a randomized-controlled trial examining time and quality of lung deflation Comparaison du bloqueur bronchique à la sonde endotrachéale à double lumière gauche en chirurgie thoracoscopique vidéoassistée: une étude randomisée contrôlée examinant le temps et la qualité de l'affaissement du poumon Abstract Introduction Double-lumen endotracheal tubes (DL-ETT) and bronchial blockers (BB) have both been used for lung isolation in video-assisted thoracic surgery (VATS). Though not well studied, it is widely thought that a DL-ETT provides faster and better quality lung collapse. The aim of this study was to compare a BB technique vs a leftsided DL-ETT strategy with regard to the time and quality of lung collapse during one-lung ventilation (OLV) for elective VATS. Methods Forty patients requiring OLV for VATS were randomized to receive a BB (n = 20) or a left-sided DL-ETT (n = 20). The primary endpoint was the time from pleural opening (performed by the surgeon) until complete lung collapse. The time was evaluated offline by reviewing video recorded during the VATS. The quality of lung deflation was also graded offline using a visual scale (1 = no lung collapse; 2 = partial lung collapse; and 3 = total lung collapse) and was recorded at several time points after pleural incision. The surgeon also graded the time to complete lung collapse and quality of lung deflation during the procedure. The surgeon's guess as to which device was used for lung isolation was also recorded. Results Of the 40 patients enrolled in the study, 20 patients in the DL-ETT group and 18 in the BB group were analyzed. There mean (standard deviation) time to complete lung collapse of the operative lung was significantly faster using the BB compared with using the DL-ETT [7.5 (3.8) min vs 36.6 (29.1) min, respectively; mean difference, 29.1 min; 95% confidence interval, 1.8 to 7.2; P\0.001]. Overall, a higher proportion of patients in the BB group than in the DL-ETT group achieved a quality of lung collapse score of 3 at five minutes (57% vs 6%, respectively; P \ 0.004), ten minutes (73% vs 14%, respectively; P = 0.005), and 20 min (100% vs 25%, respectively; P = 0.002) after opening the pleura. The surgeon incorrectly guessed the type of device used in 78% of the BB group and 50% of the DL-ETT group (P = 0.10). Conclusion The time and quality of lung collapse during OLV for VATS was significantly better when using a BB than when using a left-sided DL-ETT. Surgeons could not reliably determine which device was being used based on the time and quality of lung collapse. This trial was registered at ClinicalTrials.gov number, NCT01615263. RésuméIntroduction Les sondes endotrachéales à double lumière (SET-DL) et les bloqueurs bronchiques (BB) ont tous deux été utilisés pour isoler un poumon pendant une chirurgie thoracique vidéo-assistée (CTVA). Bien que peu étudié, on pense communément qu'une SET-DL procure un affaissement du poumon plus rapide et de m...

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“…Satisfactory lung isolation can be achieved using a double-lumen tube or a bronchial blocker. Both devices have been in clinical use for decades, but controversy persists regarding which device is superior [2][3][4][5][6][7]. A bronchial blocker can be added to a regular tracheal tube and is the preferred device for patients in whom a difficult airway is anticipated [8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Postoperative outcomes of lung separation with double-lumen tubes and bronchial blockers

Chen

Chang

et al. 2019

Preprint

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Objectives The choice between a double-lumen tube (DLT) and a bronchial blocker (BB) for lung isolation remains controversial. The aim of this study was to determine if the features of these lung isolation devices affect postoperative pulmonary outcomes. Methods We retrospectively identified claims by patients who underwent surgery under lung isolation in 2000–2012 in the Taiwan National Health Insurance Research Database. After matching for age, sex, and year of surgery, 1898 patients were enrolled in the BB group and 5694 in the DLT group. The risks of readmission in the first postoperative year with pulmonary complications, in-hospital death, and one-year mortality were estimated using conditional logistic regression analysis. Results Patients in the BB group had higher risks of readmission with pulmonary infection (adjusted odds ratio [aOR], 1.46; 95% confidence interval [CI], 1.22–1.74), respiratory failure (aOR, 1.38; 95% CI, 1.09–1.76), in-hospital deaths (aOR, 2.03; 95% CI, 1.40–2.94), and one-year mortality rate (aOR, 1.94; 95% CI, 1.60–2.35) in the first postoperative year than did those in the DLT group after adjusting for the type of surgery, difficult airway condition, hospital accreditation level, and underlying comorbidity. Patients in the BB group had longer median (interquartile range) stays in the intensive care unit (1 [0–4] versus 1 [0–3] days, P < 0.001) and in hospital (16 [10–26] versus 13 [8–22] days, respectively, P < 0.001). Conclusions Patients undergoing thoracic surgery are more likely to experience postoperative pulmonary complications related to BB than to DLT.

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Pro: Bronchial Blockers Should Be Used Routinely for Providing One-Lung Ventilation

Cited by 33 publications

References 13 publications

Atemwegsmanagement in der Thoraxanästhesie mit dem Bronchusblocker

Atemwegsmanagement in der Thoraxanästhesie mit dem Bronchusblocker

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

Postoperative outcomes of lung separation with double-lumen tubes and bronchial blockers

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