A Comparison of the Efficacy and Adverse Effects of Double-Lumen Endobronchial Tubes and Bronchial Blockers in Thoracic Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Clayton-Smith, Ana; Bennett, Kyle; Alston, R. Peter; Adams, George W.; Brown, G. A.; Hawthorne, Timothy; Hu, May Khei; Sinclair, A; Tan, Jay Roe

doi:10.1053/j.jvca.2014.11.017

Cited by 141 publications

(102 citation statements)

References 33 publications

(52 reference statements)

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“…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. 14 The authors found no significant differences between DLETTs and BBs in the time to lung collapse or in the quality of lung deflation; however, the vast majority of these studies were in thoracotomy patients. During conventional thoracotomy, it is easy for the surgeon to compensate for a non-optimal lung deflation by using a lung retractor or direct lung manual compression.…”

Section: Résumémentioning

confidence: 89%

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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Section: Résumémentioning

confidence: 89%

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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“…In clinical practice, anesthetists or intensivists have learnt to live with these limitations for years, even though the problems associated with the use of (inappropriate) DLTs are considerable. Clayton-Smith et al [8] reported an incidence of airway injuries of close to 30%, and Heir et al [20], in a study, including the VIVASIGHT ® DLT reported a rate of DLT dislodgement during positioning in almost 2/3 and during surgery in almost 1/3 of their studied patients, respectively. Nevertheless, there is little to no access to the critical DLT dimensions (i.e., by package insert), despite the call for such detail to be more readily available, which was issued over 20 years ago [18].…”

Section: Anesthesiology Research and Practicementioning

confidence: 95%

“…Irrespective of the decision to use a left-sided or right-sided DLT, choosing the appropriate size is critical. e consequences of inserting/using an inappropriately sized DLT can result in significant clinical problems, such as difficulty in ventilating the lungs' potential difficulties in letting the lung collapse, the need for tube exchange with reintubation, severe injuries to the airway, impaired surgical conditions, or even inability to perform the planned surgical procedure [2,[6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Dimensional variations of left-sided double-lumen endobronchial tubes

Hegland

Schnitzler

Ellensohn

et al. 2019

Preprint

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Background Tube size selection is critical in ventilating patients` lungs using double-lumen endobronchial tubes (DLTs). Little information about relevant parameters is readily available from manufacturers. The aim of this study is to provide reference data for relevant dimensions of conventionally available DLTs. Methods In this study in a benchmark in-vitro setup, several dimensional parameters of four sizes of left-sided double-lumen endobronchial tubes from six different manufacturers were assessed, such as distances and diameters of tube shaft, cuff lengths and diameters as well the angle at the tip. Results Endobronchial tubes of ostensibly the same size revealed wide variation in measured parameters between brands from different manufacturers. In some parameters, there was an overlap between different sizes from the same manufacturer, i.e. diameters and distances did not increase with increasing nominal endobronchial tube size. The information about dimensions of endobronchial tubes provided by manufacturers’ leaflets is insufficient. Conclusions Endobronchial tube size selection carries unnecessary uncertainty because clinically relevant parameters are unknown and vary considerably between different manufacturers.

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“…Though DLT is the more preferred choice for lung isolation (11), numerous randomised trials failed to give a significant difference between these two approaches. A systemic review and meta-analysis conducted by ClaytonSmith et al (9) …”

Section: Comparison Of Dlt and Bbmentioning

confidence: 99%

Anaesthesiology for uniportal VATS: double lumen, single lumen and tubeless

Zhao

Lau

2017

J. Vis. Surg.

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Abstract:The advent of one-lung ventilation (OLV) technique provides immobilized surgical field which is fundamental in minimally invasive thoracic surgery. Mainstem methods of achieving lung separation are either via a double-lumen endotracheal tube or placing a bronchial blocker (BB) through a single-lumen endotracheal tube. More recently, the use of non-intubated thoracic surgery (NITS) has been investigated intensively, attempting to minimise the complications that follow general anaesthesia. The aim of this review is to describe the mechanism of these techniques briefly and outlines the advantages and drawbacks of them with the comparison.

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A Comparison of the Efficacy and Adverse Effects of Double-Lumen Endobronchial Tubes and Bronchial Blockers in Thoracic Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Cited by 141 publications

References 33 publications

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

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

Dimensional variations of left-sided double-lumen endobronchial tubes

Anaesthesiology for uniportal VATS: double lumen, single lumen and tubeless

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