Lung sonography can improve the specificity of determination of left-sided double-lumen tracheal tube position in both novices and experts: a randomised prospective study

Chung, Jun-Young; Go, YoonJu; Jang, Yong Seok; Lee, Bong-Jae; Seo, Hyungseok

doi:10.1177/0300060520964369

Cited by 6 publications

(12 citation statements)

References 15 publications

(26 reference statements)

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“…Nevertheless, US provides key advantages, including wide availability, ease of use, and significantly decreased exposure to respiratory secretions, thus minimizing operator risk in situations where the patient has transmissible respiratory pathogens [ 22 , 25 ]. This study demonstrated that the time needed for confirmation and adjustment of the LDLT position was significantly shorter when using lung US compared to when using FOB (median time 3 vs. 6 min, respectively), reducing potential exposure time even further.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, several recent studies have compared US to clinical methods for DLT positioning and found that US significantly increases accuracy of LDLT placement [ 11 , 12 , 19 – 21 ]. The limited training requirements, cost effectiveness, and simplicity of lung ultrasound make it a compelling alternative to clinical assessment for LDLT positioning, but little investigation has been performed to compare US to the current gold standard of FOB [ 22 ]. One small, prospective comparison study demonstrated excellent concordance between FOB and US findings for assessment of LDLT positioning, with analyses of time and cost effectiveness analysis favoring US [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

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Lung ultrasound is non-inferior to bronchoscopy for confirmation of double-lumen endotracheal tube positioning: a randomized controlled noninferiority study

et al. 2022

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Background Appropriate placement of left-sided double-lumen endotracheal tubes (LDLTs) is paramount for optimal visualization of the operative field during thoracic surgeries that require single lung ventilation. Appropriate placement of LDLTs is therefore confirmed with fiberoptic bronchoscopy (FOB) rather than clinical assessment alone. Recent studies have demonstrated lung ultrasound (US) is superior to clinical assessment alone for confirming placement of LDLT, but no large trials have compared US to the gold standard of FOB. This noninferiority trial was devised to compare lung US with FOB for LDLT positioning and achievement of lung collapse for operative exposure. Methods This randomized, controlled, double-blind, noninferiority trial was conducted at the Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand from October 2017 to July 2019. The study enrolled 200 ASA classification 1–3 patients that were scheduled for elective thoracic surgery requiring placement of LDLT. Study patients were randomized into either the FOB group or the lung US group after initial blind placement of LDLT. Five patients were excluded due to protocol deviation. In the FOB group (n = 98), fiberoptic bronchoscopy was used to confirm lung collapse due to proper positioning of the LDLT, and to adjust the tube if necessary. In the US group (n = 97), lung ultrasonography of four pre-specified zones (upper and lower posterior and mid-axillary) was used to assess lung collapse and guide adjustment of the tube if necessary. The primary outcome was presence of adequate lung collapse as determined by visual grading by the attending surgeon on scale from 1 to 4. Secondary outcomes included the time needed to adjust and confirm lung collapse, the time from finishing LDLT positioning to the grading of lung collapse, and intraoperative parameters such has hypotension or hypertension, hypoxia, and hypercarbia. The patient, attending anesthesiologist, and attending thoracic surgeon were all blinded to the intervention arm. Results The primary outcome of lung collapse by visual grading was similar between the intervention and the control groups, with 89 patients (91.8%) in the US group compared to 83 patients (84.1%) in the FOB group (p = 0.18) experiencing adequate collapse. This met criteria for noninferiority per protocol analysis. The median time needed to confirm and adjust LDLT position in the US group was 3 min (IQR 2–5), which was significantly shorter than the median time needed to perform the task in the FOB group (6 min, IQR 4–10) (p = 0.002). Conclusions In selected patients undergoing thoracic surgery requiring LDLT, lung ultrasonography was noninferior to fiberoptic bronchoscopy in achieving adequate lung collapse and reaches the desired outcome in less time. Trial Registration This study was registered at clinicaltrials.gov, NCT03314519, Principal investigator: Kasana Raksamani, Date of registration: 19/10/2017.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Lung ultrasound is non-inferior to bronchoscopy for confirmation of double-lumen endotracheal tube positioning: a randomized controlled noninferiority study

et al. 2022

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“…One study [ 24 ] was excluded because ultrasound examination was carried out after correct placement of DLT, and two [ 25 , 26 ] studies were excluded for not using ultrasound to assess the DLT position. Finally, eight studies [ 14 , 15 , 20 , [27] , [28] , [29] , [30] , [31] ] were included in the quantitative analysis ( Fig. 1 ).…”

Section: Resultsmentioning

confidence: 99%

Preoperative lung ultrasound for confirming the double-lumen endotracheal tube position for one-lung ventilation: A systematic review and meta-analysis

Wang¹,

Lin²,

Su³

et al. 2023

Heliyon

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“…Also, Chung et al (11) found that LUS had higher ac-curacy than auscultation for detecting DLT misplacement with experts (69.8% vs. 37.5%). Moreover, Sustic et al (16) reported that LUS had higher accuracy when added to auscultation compared to auscultation alone (88% vs. 72%).…”

Section: Discussionmentioning

confidence: 99%

“…LUS is a noninvasive method that has been widely employed in airway management in the past years and can be used to assess the placement of the endotracheal tube even in an emergency (4,9). Even in thoracic surgery, LUS has shown to be a superior approach and enhances auscultation accuracy for determining the proper placement of DLTs due to its high sensitivity and specificity (10,11). Moreover, LUS is a compelling alternative to FOB because of its simplicity and less required training (12).…”

Section: Introductionmentioning

confidence: 99%

Role of Lung Ultrasound in Confirmation of Double Lumen Endotracheal Tube Placement for Thoracic Surgeries: A Prospective Diagnostic Accuracy Study

2022

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Background: In thoracic surgeries requiring thoracotomy incisions, correct positioning of the double-lumen endotracheal tube (DLT) is mandatory. After the pandemic of novel COVID-19, using simple, noninvasive technology such as lung ultrasound (LUS) can be important in avoiding the possibility of spreading infectious diseases or contagious infections that can follow using fiberoptic bronchoscopy (FOB). Objectives: We aimed to assess the accuracy of auscultation and LUS in relation to FOB in the assessment of DLT placement and to identify the possibility of using LUS as an alternative to FOB during DLT insertion. Methods: This prospective cohort study was conducted according to STARD guidelines; enrolled 120 cases requiring DLT intubation. After DLT insertion, all patients were examined by stethoscope, then by LUS for determination of DLT position, and then confirmed by FOB in the same patient. Results: Three patients dropped out due to failed intubation, and only 117 cases were analyzed. Time was significantly longer for LUS than for auscultation and FOB and was insignificantly different between auscultation and FOB. Auscultation had 76.14% sensitivity, 34.48% specificity, and 65.81% accuracy in the determination of correct DLT placement. LUS had 92.05% sensitivity, 79.31% specificity, and 88.89% accuracy in detecting correct DLT placement. There was substantial agreement between LUS and FOB (κ = 0.705) and poor agreement between auscultation and FOB (κ = 0.104). Conclusions: LUS can be used as a simple, noninvasive tool for detecting DLT placement with a substantial agreement with FOB.

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Lung sonography can improve the specificity of determination of left-sided double-lumen tracheal tube position in both novices and experts: a randomised prospective study

Cited by 6 publications

References 15 publications

Lung ultrasound is non-inferior to bronchoscopy for confirmation of double-lumen endotracheal tube positioning: a randomized controlled noninferiority study

Lung ultrasound is non-inferior to bronchoscopy for confirmation of double-lumen endotracheal tube positioning: a randomized controlled noninferiority study

Preoperative lung ultrasound for confirming the double-lumen endotracheal tube position for one-lung ventilation: A systematic review and meta-analysis

Role of Lung Ultrasound in Confirmation of Double Lumen Endotracheal Tube Placement for Thoracic Surgeries: A Prospective Diagnostic Accuracy Study

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