The Video Double-Lumen Endobronchial Tube: Is the Benefit Worth the Cost?

Templeton, T. Wesley; Morris, Benjamin N.; Royster, Roger L.

doi:10.1053/j.jvca.2017.06.021

Cited by 5 publications

(5 citation statements)

References 7 publications

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“…Cost-effectiveness analysis was performed by Larsen et al ( 17 ); with the assumption of 6.6% incidence of additional FOB for tube positioning, the use of VDLT turned out favourable. A different approach is discussed by Templeton et al ( 18 ), as the cost of maintaining FOB for immediate use may vary among institutions; with four times higher cost of VDLT compared with DLT for a single tube, the cost-effectiveness may not always be favourable.…”

Section: Discussionmentioning

confidence: 99%

A randomized comparison between the VivaSight double-lumen tube and standard double-lumen tube intubation in thoracic surgery patients

Palaczyński¹,

Misiołek²,

Białka³

et al. 2022

J Thorac Dis

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Background: Thoracic surgery often demands separation of ventilation between the lungs. It is achieved with double-lumen tubes (DLTs), video double-lumen tubes (VDLTs) or bronchial blockers. We tested the hypothesis that intubation with the VivaSight double-lumen tube would be easier and faster than with a standard DLT.Methods: Seventy-one adult patients undergoing thoracic procedures that required general anaesthesia and one-lung ventilation (OLV) were enrolled in this randomized, prospective study. Patients were randomly assigned to procedure of intubation with a standard DLT or VDLT. The collected data included: patients' demographics, surgery information, anthropometric tests used for difficult intubation prediction, specifics of intubation procedure, tube placement, fiberoptic bronchoscopy (FOB) use, lung separation, trachea temperature, and reported complications of intubation.Results: For DLTs compared to video-double lumen tubes, intubation time was significantly longer (125 vs. 44 s; P<0.001), intubation graded harder (P<0.05) and FOB use was more prevalent [8 (20.5%) vs. 0; P<0.05]. Conclusions:The use of VDLTs when compared with standard-double lumen tubes offers reduced intubation time and is relatively easier. Also, the reduced need for fibreoptic bronchoscopy may improve the cost-effectiveness of VDLT use. In addition, constant visualization of the airways during the procedure allows to quickly correct or even prevent the tube malposition.Trial Registration: The study was registered in the ClinicalTrials.gov registry, ID: NCT04101734.

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Section: Discussionmentioning

confidence: 99%

A randomized comparison between the VivaSight double-lumen tube and standard double-lumen tube intubation in thoracic surgery patients

Palaczyński¹,

Misiołek²,

Białka³

et al. 2022

J Thorac Dis

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“…Over the decades, designs of DLT and EBBs have been revised to improve their intraoperative use and decrease iatrogenic injury. Video DLT by VivaSight VDLT (ETView Medical Ltd., Misgav, Israel) is available and allows a continuous intraoperative visualization of the position of DLT during OLV via a camera attached over the tracheal lumen of the tube [ 8 ]. Several designs of BBs are available commercially for intraoperative lung isolation.…”

Section: Discussionmentioning

confidence: 99%

A Case Report of Iatrogenic Bronchial Rupture following Endobronchial Blocker Placement

Alshoubi

Khan

DeJesus

et al. 2022

Case Reports in Critical Care

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Physiologists Eduard Pfluger and Claude Bernard first introduced one lung ventilation (OLV) in 1871. Today, it is now a frequently used technique in open or minimally invasive cardiothoracic surgeries. One key benefit of the use of OLV is improved surgical exposure. Historically, lung isolation catheters used under fluoroscopic guidance or a Fogarty catheter were used to achieve OLV. In present times, endobronchial blockers (EBBs) in conjunction with single lumen endotracheal tubes and double lumen endotracheal tubes (DLTs) are used to achieve intraoperative OLV. Some complications of EBBs include mucosal injury, bleeding, bronchial rupture, pneumothorax, malpositioning-induced respiratory arrest, severe hypoxemia, and dislodgement. The incidence of iatrogenic tracheal rupture with single lumen endotracheal intubation is reported to be approximately 0.005%, and with double lumen ETT, the incidence may be between 0.05 and 0.19%. Mortality associated with tracheal rupture with DLTs is approximately 8.8%. Data on airway injury with endobronchial blockers is limited, and reported cases of bronchial perforations with use of EBBs are rare suggesting that EBBs may be the safer option for OLV. In this case report, we will be discussing a case of iatrogenic endobronchial rupture following endobronchial blocker placement.

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“…Although the high volume of data is one of the strengths of this study, the volume of cases in the subgroups of airway assessment was too small to analyse. Examination of the cost-effectiveness of the vDLT was beyond the scope of this study; however, this has been evaluated in previous cohorts where FOB is associated with higher cost of acquisition, decontamination and repair (Heir et al 2018, Koopman et al 2015, Templeton et al 2018). Furthermore, avoiding the use of FOB results in significant reduced intubation time, and for the patients with reduced pulmonary reserve, a prolonged time to intubation increases the risk of hypoxemia and hypercapnia.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of time to intubation and rate of success for different healthcare professionals using a double-lumen left-sided endotracheal video tube: A prospective observational study

Pedersen

Green

Bigler

et al. 2020

Journal of Perioperative Practice

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Intubation with a double-lumen left-sided endotracheal video tube has been the standard procedure for nearly five years in the Department of Cardiothoracic Surgery, Copenhagen University Hospital, but no systematic evaluations have been done. For a 12-month period ending November 2017, data were collected from 579 consecutive patients, scheduled for thoracic surgery with a requirement for one-lung ventilation; 35 anaesthetist trainees (nurses or doctors) (287 cases), 27 nurse anaesthetists (239 cases) and 8 anaesthesiologists (53 cases) managed intubation with a double-lumen tube. Time to intubation was relatively equal across healthcare professionals with a mean time of 53 (anaesthetist trainees), 40 (nurse anaesthetists) and 63 (anaesthesiologists) seconds. The shorter time for nurse anaesthetists and prolonged time for anaesthesiologists might be due to the small number of cases and the fact that anaesthesiologists carried out 60% of the cases, where a third attempt was needed, and 25% of cases for the anaesthesiologists were assessed to a Cormack-Lehane grade of 3 or 4 compared to 6% for anaesthetist trainees and 5% for nurse anaesthetists. The rate of successful placement in the first attempt of placing the double-lumen left-sided endotracheal video tube was high, which emphasises that intubation with a double-lumen left-sided endotracheal video tube is suitable for use by different healthcare professionals.

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The Video Double-Lumen Endobronchial Tube: Is the Benefit Worth the Cost?

Cited by 5 publications

References 7 publications

A randomized comparison between the VivaSight double-lumen tube and standard double-lumen tube intubation in thoracic surgery patients

A randomized comparison between the VivaSight double-lumen tube and standard double-lumen tube intubation in thoracic surgery patients

A Case Report of Iatrogenic Bronchial Rupture following Endobronchial Blocker Placement

Evaluation of time to intubation and rate of success for different healthcare professionals using a double-lumen left-sided endotracheal video tube: A prospective observational study

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