Reliability of auscultation in positioning of double-lumen endobronchial tubes

Alliaume, B.; Coddens, J.; Deloof, Thierry

doi:10.1007/bf03008231

Cited by 97 publications

(36 citation statements)

References 15 publications

(4 reference statements)

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“…Other studies report the incidence of malpositioning of left-sided DLTs to range from 10-83% (weighted mean, 53%). [1][2][3][4][5]15 One effect of the higher than anticipated incidence of malposition of DLTs is that the number of patients enrolled is generous. Our rather stringent definition of device malposition may be responsible for the high rate of malpositions we report.…”

Section: Discussionmentioning

confidence: 99%

“…It is recommended that bronchoscopy be used to verify the correct position because the incidence of malpositions is high. [1][2][3][4][5] The major disadvantage of DLTs is the often difficult placement because of the larger diameter; as a consequence, patients often complain of hoarseness or sore throat. 6 There is also a potential for minor laryngeal, tracheal, and bronchial trauma.…”

mentioning

confidence: 99%

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Efficiency, Efficacy, and Safety of EZ-Blocker Compared with Left-sided Double-lumen Tube for One-lung Ventilation

Mourisse

Liesveld

Verhagen³

et al. 2013

Anesthesiology

122

119

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Background: Double-lumen tubes (DLTs) or bronchial blockers are commonly used for one-lung ventilation. DLTs are sometimes difficult or even impossible to introduce, and the incidence of postoperative hoarseness and airway injuries is higher. Bronchial blockers are more difficult to position and need more frequent intraoperative repositioning. The design of a Y-shaped bronchial blocker, the EZ-Blocker (Teleflex Life Sciences Ltd., Athlone, Ireland) (EZB), combines some advantages of both techniques. The objective of this study was to assess whether EZB performs clinically better than left-sided DLTs (Broncho-cath; Mallinckrodt, Athlone, Ireland) without causing more injury. Primary outcome was the frequency of initial malpositions. Methods: Eligible patients were adults scheduled for surgery requiring one-lung ventilation who met criteria for placement of both devices. In this parallel trial, 100 consecutive and blinded patients were assigned randomly using a computer-generated list to two groups. The incidence of malposition and ease and time of placement were recorded. Blinded assessors investigated quality of lung deflation, postoperative complaints, and damage to the airway.Results: Placement of a DLT was unsuccessful twice. The incidence of initial malposition was high and comparable between EZBs (37 of 50) and DLTs (42 of 49) (P = 0.212). Placing single-lumen tubes and EZBs took more time but was rated easier. Quality of lung deflation was comparable. Fewer patients in the EZB group complained of sore throat at day 1. There was a higher incidence of tracheal hematoma and redness and bronchial hematoma in the DLT group. Conclusions:The EZB is an efficient and effective device for one-lung ventilation and causes less injury and sore throat than a DLT.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Efficiency, Efficacy, and Safety of EZ-Blocker Compared with Left-sided Double-lumen Tube for One-lung Ventilation

Mourisse

Liesveld

Verhagen³

et al. 2013

Anesthesiology

122

119

View full text Add to dashboard Cite

show abstract

“…Different malposition scenarios may be deduced depending on type of DLT (L v. R), intended mainstem to be intubated, DLT lumen occluded and the absence or presence of breath sounds. Although auscultation is an important tool in situations where fiberoptic bronchoscopy is unavailable, studies have shown a large margin of positioning error when it is not used [15][16][17][18]. Fiberoptic confirmation is required for proper positioning of bronchial blockers because they lack basic ergonomic design features that enable blind placement (like curvature or specialized ventilation port configurations of DLTs).…”

Section: Confirming Proper Lung Isolationmentioning

confidence: 99%

Anesthesia for Thoracic Surgical Procedures

Tsai¹,

Moon²,

Vachhani³

et al. 2013

Principles and Practice of Cardiothoracic Surgery

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“…Auscultation of breath sounds has limited sensitivity and depends on the experience of the listener. [2][3][4][5][6][7][8] Colorimetric end-tidal carbon dioxide detectors are simple to use, inexpensive, and have a high sensitivity and specificity to accurately differentiate between esophageal and tracheal intubation in the patient with good lung perfusion. 9 Vibration response imaging (VRI) is a novel, non-invasive, computer-based technology that measures vibration energy of lung sounds during respiration.…”

Section: éLéments Cliniques : L'imagerie Par Réponse Vibratoire (Vri)mentioning

confidence: 99%

Case report: Vibration response imaging findings following inadvertent esophageal intubation

Cinel

Smith

Tay

et al. 2008

Can J Anesth/J Can Anesth

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Purpose:We describe the effect that inadvertent esophageal intubation has on the images and on the vibration distribution of vibration response imaging (VRI). Clinical features:Vibration response imaging (VRI) is a novel, non-invasive, computer-based technology that measures vibration energy of lung sounds during respiration and displays regional intensity, in both visual and graphic format. Vibration response images, obtained prior to tracheal intubation (spontaneous breathing) and during endotracheal ventilation using a controlled mode, resulted in evenly distributed vibrations throughout the patient's lungs. During inadvertent esophageal ventilation, however, the majority of vibrations were detected in the upper regions of the image, compared to those of the lower (60% vs 8%, respectively). During spontaneous breathing and endotracheal ventilation, the midclavicular column of sensors, located over the centre of each lung, detected more vibrations compared to either the medial or the axillary column of sensors. During inadvertent esophageal ventilation, more vibrations were detected by the medial column of sensors (nearest to the midline/esophagus); and fewer were detected by the sensors that were positioned more laterally. Conclusion: This report illustrates the potential for a visual image of distribution of lung vibration energy to differentiate endotracheal intubation from inadvertent esophageal intubation. Éléments cliniques : L'imagerie par réponse vibratoire (VRI) est une nouvelle technologie informatique non invasive qui mesure l'énergie de vibration des sons pulmonaires pendant la respiration et affiche l'intensité régionale en format visuel et graphique. Les images de réponse vibratoire obtenues avant l'intubation trachéale (respiration spontanée) et pendant la ventilation endotrachéale à l'aide d'un mode contrôlé ont eu pour résultat des vibrations uni-

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Reliability of auscultation in positioning of double-lumen endobronchial tubes

Abstract: Reliability of auscultation in positioning of double-lumen endobronchial tubes Auscultation is a well-established technique to confirm the position of double-lumen endobronchial tubes (DLTs

Cited by 97 publications

References 15 publications

Efficiency, Efficacy, and Safety of EZ-Blocker Compared with Left-sided Double-lumen Tube for One-lung Ventilation

Efficiency, Efficacy, and Safety of EZ-Blocker Compared with Left-sided Double-lumen Tube for One-lung Ventilation

Anesthesia for Thoracic Surgical Procedures

Case report: Vibration response imaging findings following inadvertent esophageal intubation

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