Comparison of left double lumen tube and y-shaped and double-ended bronchial blocker for one lung ventilation in thoracic surgery—a randomised controlled clinical trial

Abstract

Background Double lumen tube (DLT) intubation is the most commonly used technique for one lung ventilation. Bronchial blockers (BB) are an alternative, especially for difficult airways. The EZ-bronchial blocker (EZB) is an innovative y-shaped and double-ended device of the BB family. Methods A randomised, controlled trial was conducted in 80 patients undergoing elective thoracic surgery using DLT or EZB for one lung ventilation (German Clinical Trial Register DRKS00014816). The objective of the study was to compare the clinical performance of EZB with DLT. Primary endpoint was total time to obtain successful one lung ventilation. Secondary endpoints were time subsections, quality of lung collapse, difficulty of intubation, any complications during the procedure, incidence of objective trauma of the oropharynx and supraglottic space and intubation-related subjective symptoms. Results 74 patients were included, DLT group (n = 38), EZB group (n = 36). Median total time to obtain one lung ventilation [IQR] in the DLT group was 234 s [207 to 294] versus 298 s [243 to 369] in the EZB group (P = 0.007). Median total time was relevantly influenced by different preparation times. Quality of lung collapse was equal in both groups, DLT group 89.5% were excellent vs. 83.3% in the EZB group (P = 0.444). Inadequate lung collapse in five patients of the EZB group resulted in unsuccessful repositioning attempts and secondary DLT placement. Endoscopic examinations revealed significantly more carina trauma (P = 0.047) and subglottic haemorrhage (P = 0.047) in the DLT group. Postoperative subjective symptoms (sore throat, hoarseness) were more common in the DLT group, as were speech problems. Conclusions Using EZB prima facie results in prolonged time to obtain one lung ventilation with equal quality of lung collapse for the thoracic surgeon. If preparation times are omitted in the analysis, the time difference is statistically and clinically not relevant. Our data showed only little evidence for reducing objective airway trauma as well as subjective complaints. In summary both procedures were comparable in terms of times and clinical applicability. Therefore decisions for DLT or EZB should depend more on individual experience, in-house equipment and the individual patient, than on any times that are neither clinically significant nor relevant. Trial registration German Clinical Trial Register DRKS00014816, prospectively registered on 07.06.2018

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

“…21 Thus, five full-text citations were included in the review from the primary literature search. [22][23][24][25][26] Hand-searching of conference proceedings, grey literature, and reference lists of included citations yielded one additional study that satisfied the inclusion criteria. 27 Ultimately, six RCTs were included in this systematic review.…”

“…Across all included studies, 495 patients underwent thoracic surgery requiring OLV, for which a L-DLT was used in 249 patients and a EZB was used in 246 patients. [22][23][24][25][26][27] Side of thoracotomy was leftsided in 51%, right-sided in 48%, and bilateral in 1% of included patients; this was similar between the L-DLT and EZB groups. 23,24,27 No differences were observed in all assessed patient demographic variables; however, Mallampati score was found to be greater in the L-DLT group compared to the EZB group (P = .0195).…”

“…Time to device placement from laryngoscopy to proper device placement confirmation was reported in all six studies, encompassing 493 patients (L-DLT: 247; EZB: 246). [22][23][24][25][26][27] L-DLT placement was significantly faster by a WMD [95% CI] of À61.24 seconds [À102.48, À20.00] (P = .004). This outcome was associated with a high level of heterogeneity (I 2 = 75%).…”

A comparison between bronchial blockers and double-lumen tubes for patients undergoing lung resection: A propensity score-matched cohort study

“…It has been reported by a previous meta-analysis that both of the two techniques show a similar quality of lung collapse for patients with normal stature [5]. Otherwise, between the two techniques, DLT is the more frequently used device, and can be easy to place only via laryngoscope and auscultation [21][22][23][24][25]. However, DLT is more rigid and has a larger diameter, which proves to be difficult or even impossible in patients with airway abnormalities and increases the incidences of airway injuries, postoperative sore throat and even vocal paralysis under an oversized selecting size [21,[26][27].…”

“…A growing body of literature has proven that BB is more advantageous than DLT for difficult airways and significantly reduces the incidences of airway injuries and sore throat 8 , 23 . However, confirmation of the BB's position in a bronchus needs the guidance of fiberoptic bronchoscope, which takes more time than DLT and puts forward the higher requirements for the anesthesiologists 24 , 25 . Moreover, the incidence of malposition for BB is much higher particularly in patients accepting the right side-BB intubation 21 , 26 , 28 and it should also be noted that BB insertion has a risk of bronchial rupture if misapplied 29 , or being included in the surgical staple line 30 .…”