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

Abstract

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.

Video double-lumen tubes: how much room for improvement can they provide?

“…The difference in FOB usage reported by the authors is still higher than the limit of 6.6% proposed by Larsen et al ( 24 ), but the more experienced operator, the lesser the need for FOB verification and the lesser the economic superiority. Moreover, the rate of tube repositioning in the study by Palaczynski et al is higher in the VDLT group, pretty close to statistical significance ( 15 ).…”

“…Nevertheless, the most remarkable difference to previous evidence is the percentage of FOB usage both for intubation and for repositioning of the DLT. Palaczynski et al report a much lower need than previous studies since it was not necessary in any case of the VDLT group and only in 20.5% of the conventional DLT group (15). This again raises the issue of the real need for systematic FOB to verify the location of the DLTs, and even to reposition them, provided that airway management is performed by experienced professionals (as seems to be the case).…”

“…It seems so. The data obtained by Palaczynski et al ( 15 ) point to an easier intubation, a faster procedure, and a less frequent need for FiberOptic Bronchoscopy (FOB), among others.…”

A Randomized Study of Rigid Video Stylet versus Macintosh Laryngoscope for Double-Lumen Endobronchial Tube Intubation Assistance in Thoracoscopic Pulmonary Surgery

“…Video laryngoscope-assisted DLT intubation has been proved to be superior over traditional direct laryngoscope in terms of the intubation time and glottic view in multiple studies [ 14 ]. Not only the assisting tools that have been developed but DLT itself could be equipped with a video system, and this consequently reduces the need for fiberoptic bronchoscopy [ 15 ], with which the intubation time could be shortened and the success rate could be improved for senior anesthesiologists in a manikin model [ 16 ]. Limited studies on video stylets in ET/DLT intubations have demonstrated their values in clinical use.…”

“…Hsu et al [ 6 ] proved that the Trachway ® stylet could achieve faster left-sided DLT intubation (24 ± 4 s) compared with that of ML (48 ± 11 s) in a total sample size of 60. In a clinical study with a much larger sample size, Yang et al [ 5 ] found that compared with ML, the Optiscope ® RVS (Pacific Medical, Seoul, Republic of Korea) not only reduced DLT intubation time (15 s [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ], but it also improved first-attempt success rates significantly in both left- and right-sided DLT intubation. Seo H and colleagues [ 17 ] even successfully used Clarus stylet-assisted DLT intubation for a patient with a possibly difficult airway.…”