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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
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...
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| Autoren: | , , , , , , , |
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| Format: | Artikel |
| Sprache: | Englisch |
| Veröffentlicht: |
Philipps-Universität Marburg
2022
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| Schlagworte: | |
| Online Zugang: | PDF-Volltext |
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| Zusammenfassung: | 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. |
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| Beschreibung: | Gefördert durch den Open-Access-Publikationsfonds der UB Marburg. |
| DOI: | 10.1186/s12871-022-01637-1 |