Which device should be considered the best for lung isolation: double-lumen endotracheal tube versus bronchial blockers

Campos, Javier H.

doi:10.1097/aco.0b013e3280111e2a

Cited by 163 publications

(91 citation statements)

References 36 publications

(35 reference statements)

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“…Actuellement la plupart des interventions en chirurgie thoracique exigent une isolation pulmonaire ou une intubation uni pulmonaire, réalisée par les TDL ou des bloqueurs bronchiques. 10,11 Les TDL peuvent poser des problèmes d'intubation, même en l'absence de données prédictives d'intubation difficile. Ces problèmes sont d'ordre technique en rapport avec le type de tube et sa morphologie spéciale (diamètre, taille, courbure de l'extrémité bronchique, présence de l'éperon et rigidité de l'ensemble du tube).…”

Section: Discussionunclassified

Le vidéolaryngoscope permet une intubation avec un tube à double lumière plus rapide que le laryngoscope standard

Bensghir

Alaoui

Azendour³

et al. 2010

Can J Anesth/J Can Anesth

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Purpose This study was designed to compare videolaryngoscopy with direct laryngoscopy with respect to ease of intubation when inserting a double lumen tube (DLT). Methods In this prospective randomized study 68 patients American Society of Anesthesiologists (ASA) physical status I and II were included. Patients with criteria indicating possible difficult intubation were excluded. The patients were randomized into two groups, depending on the tool used to facilitate intubation: videolaryngoscope (VL group) or direct laryngoscopy (DL group). The time required for intubation was the primary endpoint. Cormack and Lehane glottic visualization (CL) scores, the need for external laryngeal maneuvers and the number of attempts were measured. Results Glottic visualization was better in the VL group than in the DL group. The CL scores were I, II and III in 24, eight and two patients, respectively, in the VL group compared with 13, 11 and eight in the DL group (P = 0.025). Patients in the VL group required fewer attempts than the DL group (P = 0.019). Intubation time was 39.9 ± 4.4 sec in the VL group and 47.9 ± 5.4 sec in the DL group (P \ 0.001). No intubation failure was noted in group VL compared with two in the DL group (not significant). Conclusion The use of a videolaryngoscope reduces the time required for intubation with a DLT compared with the direct laryngoscopy in elective thoracic surgery.

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Section: Discussionunclassified

Le vidéolaryngoscope permet une intubation avec un tube à double lumière plus rapide que le laryngoscope standard

Bensghir

Alaoui

Azendour³

et al. 2010

Can J Anesth/J Can Anesth

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“…7 Use of a bronchial blocker allowed OLV regardless of the anatomical distortion and bronchial diameter. 13 Use of a number of different bronchial blocker systems have been reported in patients with a tracheal bronchus requiring OLV. 6,11 In the present case, we thought that the Arndt system would be useful because the bronchial blocker had to pass through a bifurcation site twice in order to reach the left main bronchus; thus, it might have been more difficult to place a bronchial blocker without any intrinsic wire guidance.…”

Section: Discussionmentioning

confidence: 99%

The implications of a tracheal bronchus on one-lung ventilation and fibreoptic bronchoscopy in a patient undergoing thoracic surgery: a case report

Moon

Kim

Lee

2014

Can J Anesth/J Can Anesth

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Purpose Due to its anatomical complexity, a tracheal bronchus has important clinical implications for one-lung ventilation (OLV). We present a case of successful OLV in a patient with a high a type I (i.e., high take-off) tracheal bronchus. This anomaly presented unusual fibreoptic bronchoscopic (FOB) views that were difficult to discern from the normal carinal bifurcation. Clinical features A 35-yr-old male presented for posterior basal segmentectomy of the left lower lobe under video-assisted thoracoscopy. The preoperative chest radiography was reported as normal, but a computed tomography scan of the chest revealed a right upper lobe tracheal bronchus. The inlet of the tracheal bronchus was located high above the carina, and the distal trachea had significant narrowing. Because the main trachea was divided into a tracheal bronchus and a distal trachea with similar diameters and with an acute angle of divergence, FOB views of the tracheal bronchus take-off appeared similar to the normal carinal bifurcation. Moreover, the actual carina had an atypical appearance with the main bronchi shifted laterally and a blunted carinal ridge. As a result of this atypical tracheobronchial anatomy, we used an Arndt endobronchial blocker system instead of a double-lumen tube (DLT) for right-sided OLV. One-lung ventilation was satisfactory throughout the uncomplicated operation. Conclusion Careful preoperative assessment of tracheobronchial anatomy is imperative in order to choose an appropriate method of OLV and prevent potential complications. In a type I tracheal bronchus with a narrowed distal trachea, a bronchial blocker may have advantages over the conventional DLT in achieving OLV. RésuméObjectif Compte tenu de sa complexité anatomique, une bronche trachéale a d'importantes implications cliniques sur la ventilation à un seul poumon (OLV). Nous présentons un cas d'OLV réussie chez un patient ayant un type I haut, c'est-à-dire un embranchement haut-situé de la bronche trachéale. En bronchoscopie à fibre optique (FOB), cette anomalie présentait des images peu communes difficiles à discerner d'une carène de bifurcation normale. Caractéristiques cliniques Un homme âgé de 35 ans a été hospitalisé pour segmentectomie basale postérieure du lobe inférieur gauche par thoracoscopie assistée par vidéo. La radiographie préopératoire du thorax a été décrite comme normale, mais une tomodensitométrie du thorax a révélé une bronche trachéale du lobe supérieur droit. Le départ de la bronche trachéale était situé haut par rapport à la carène et la trachée distale était significativement rétrécie. Dans la mesure où la trachée proprement dite se divisait en bronche trachéale et en trachée distale, aux Author contributions Young-Jin Moon and Sung-Hoon Kim were responsible for the conception of the case report and writing the manuscript. Sang-Wook Park and Yu-Mi Lee were involved in anesthetic management of the patient and also gave important suggestions during manuscript preparation.

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“…BB'lerde malpozisyon insidansı daha fazladır. Her iki havayolu gereci yerleştirildikten sonra, klinik performans, her ikisi ile de benzer bulunmuştur [27,28] .…”

Section: çİft Lümenli̇ Tüplerle Bronşi̇al Blokerleri̇n Karşilaştirilmasiunclassified

Does the Future Belong to Bronchial Blockers?

Hoşten¹,

Aksu²

2014

GKDA Derg

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Which device should be considered the best for lung isolation: double-lumen endotracheal tube versus bronchial blockers

Abstract: Double-lumen endotracheal tubes and bronchial blockers should be part of the armamentarium of every anesthesiologist involved in lung isolation techniques and every device should be tailored to specific case needs.

Cited by 163 publications

References 36 publications

Le vidéolaryngoscope permet une intubation avec un tube à double lumière plus rapide que le laryngoscope standard

Le vidéolaryngoscope permet une intubation avec un tube à double lumière plus rapide que le laryngoscope standard

The implications of a tracheal bronchus on one-lung ventilation and fibreoptic bronchoscopy in a patient undergoing thoracic surgery: a case report

Does the Future Belong to Bronchial Blockers?

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