Intubation with VivaSight or conventional left-sided double-lumen tubes: a randomized trial

Abstract

Introduction Double-lumen endotracheal tubes (DLTs), which are commonly used for single-lung ventilation during surgery, are difficult to insert. In addition, they often move during surgical lung manipulation which can cause lifethreatening complications. Flexible bronchoscopy is used routinely to establish and confirm proper DLT placement. The newly designed VivaSight DLT has an integrated camera, allowing continuous visualization of its position in the trachea. We hypothesized that the time to intubation using the VivaSight DLT would be faster than with a conventional DLT. Methods We enrolled 40 adults scheduled for thoracic surgery. Patients were randomized to conventional DLT (n = 20) or VivaSight DLT (n = 20). Time to intubation was our primary outcome. Secondary outcomes were insertion success without flexible bronchoscopy, frequency of tube displacement, ease of insertion, quality of lung collapse, postoperative complaints, and airway injuries. Results Time [mean (SD)] to successful intubation was significantly faster with the VivaSight DLT [63 (58) sec] compared with the conventional DLT [97 (84) sec; P = 0.03]. The VivaSight DLTs were correctly inserted during all attempts. When malpositioning of the VivaSight DLT occurred, it was easily remedied, even in the lateral position. The devices were comparable with respect to postoperative coughing, hoarseness, and sore throat. Airway injuries tended to be more common with the VivaSight DLT, although this study was underpowered for airway injuries.Author contributions Rolf Schuepbach and Bastian Grande made substantial contributions to study conception and design, acquisition of data, and manuscript writing. Giovanni Camen and Alexander R. Schmidt made substantial contributions to acquisition and interpretation of data and helped draft the manuscript. Henrik Fischer made substantial contributions to analysis and interpretation of data and revised the article for important intellectual content. Daniel I. Sessler made substantial contributions to study conception and design, analysis and interpretation of data, and drafting the manuscript. Burkhardt Seifert made substantial contributions to analysis and interpretation of data and revised the manuscript for intellectual content. Donat R. Spahn made substantial contributions to study conception and design and assisted with manuscript revision. Kurt Ruetzler made substantial contributions to study conception and design; acquisition of data analysis and interpretation; and was responsible for drafting the manuscript. Single-lung ventilation is required in several clinical situations and for various surgical procedures. Perhaps the most frequent indication is thoracic surgery during

Comparison of VivaSight double‐lumen tube with a conventional double‐lumen tube in adult patients undergoing video‐assisted thoracoscopic surgery

“…The main weakness of this study is the fact that the intubating anaesthesiologist was not blinded to the device used. A similar recent study found that the mean (SD) intubating time with the VivaSight DL was significantly shorter than a conventional DLT (63 (58) s vs. 94 (84) s, p = 0.03), the latter value for conventional DLT being much shorter [14] than measured in our study. We attribute this difference to the time for preparation and use of the fibreoptic bronchoscope.…”

Safe and effective positioning of a left-sided double-lumen tube

“…As discussed in our paper, 1 positioning the VivaSight DLT 34 sec faster than positioning a conventional doublelumen tube is of marginal clinical importance. Then again, faster insertion is consistent with the fact that the tube is easy to use.…”

Placement of VivaSightTMdouble lumen tube

“…Since Vivasight-DL is now available in sizes 35, 37, 39, and 41 Fr, we think that the Brodsky criteria [2] could be helpful in selecting the appropriate size of a double-lumen tube (DLT) for a specific patient. However, we often tend to choose a smaller DLT, as using 35 Fr DLTs produces similar outcomes to using larger sizes [3].…”

“…They also comment that time to intubation in the control group included the time to use the FOB, leading to a particularly prolonged 'intubation time'. In comparison, Schuepbach et al [3] found that the mean time to correct placement by auscultation for the VivaSight vs conventional DLT was 63 s vs 97 s.…”

“…The intubation difficulty scale (IDS) has previously been used to evaluate the effectiveness of various videolaryngoscopes [2,3] and video stylets [4], and during nasotracheal intubation when modified by the N4 grading of glottic opening according to Ovassapian et al [5] and the N7 grading according to Ono et al [6].…”