Dataset Information

A novel combined approach to placement of a double lumen endobronchial tube using a video laryngoscope and fiberoptic bronchoscope: a retrospective chart review.

ABSTRACT:

Background

The objective of this study was to evaluate a modern combined video laryngoscopy and flexible fiberoptic bronchoscope approach to placement of a double lumen endobronchial tube and further characterize potential strengths and weaknesses of this approach.

Methods

Retrospective chart review was conducted at our single institution, academic medical center, tertiary-care hospital. Patients aged 18 years of age or older were evaluated who underwent thoracic surgery and one-lung ventilation with placement of a double lumen endobronchial tube using a novel combined video laryngoscopy and flexible fiberoptic bronchoscope approach. No interventions were performed.

Results

Demographics and induction and intubation documentation were reviewed for 21 patients who underwent thoracic surgery and one-lung ventilation with placement of a double lumen endobronchial tube using a novel combined video laryngoscopy and flexible fiberoptic bronchoscope approach. First pass success using the combined approach was 86% (18/21). The five patients with an anticipated difficult airway had successful double lumen endobronchial tube placement on the first attempt. There were no instances of desaturation during double lumen endobronchial tube placement. No airway complications related to double lumen endobronchial tube placement were recorded.

Conclusion

Use of a combined approach employing video laryngoscopy and a flexible fiberoptic bronchoscope may represent a reliable alternative approach to placement of double lumen endobronchial tubes.

SUBMITTER: Maracaja L

PROVIDER: S-EPMC11010390 | biostudies-literature | 2024 Apr

REPOSITORIES: biostudies-literature

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Publications

A novel combined approach to placement of a double lumen endobronchial tube using a video laryngoscope and fiberoptic bronchoscope: a retrospective chart review.

Maracaja Luiz L Coffield Alexandra A Smith L Daniela LD Bradshaw J David JD Saha Amit K AK McLauglin Christopher S CS Templeton T Wesley TW

BMC anesthesiology 20240412 1

<h4>Background</h4>The objective of this study was to evaluate a modern combined video laryngoscopy and flexible fiberoptic bronchoscope approach to placement of a double lumen endobronchial tube and further characterize potential strengths and weaknesses of this approach.<h4>Methods</h4>Retrospective chart review was conducted at our single institution, academic medical center, tertiary-care hospital. Patients aged 18 years of age or older were evaluated who underwent thoracic surgery and one-l ...[more]

PMID: 38609865

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Project description:ObjectiveTo compare the modified strategy for the right-sided double-lumen tube (R-DLT) placement using a combination of CT measurements and flexible video bronchoscopy guidance with traditional bronchoscopy technique.Trial design, setting and participantsDouble-blind, parallel randomised control trial at a tertiary care medical centre in China. 100 patients undergoing video-assisted thoracoscopic surgery and requiring R-DLT were randomly allocated to the control group and the intervention group.InterventionThe control group used the traditional bronchoscopy-guided technique. In the intervention group, the length and anteroposterior diameter of the right main bronchus (RMB) were measured on CT images to select the side and size of the Rüsch tube, and then a black depth marker was placed on the tube according to the difference between the length of the RMB and the bronchial cuff. Under the guidance of bronchoscopy, the depth marker should be placed parallel to the tracheal carina and a characteristic white line on the tube should be parallel to the midline of the tracheal carina.Main outcomesThe primary endpoint was the positioning of right upper lobe (RUL) ventilatory slot and RUL bronchial orifice. The secondary endpoints included intubation data and perioperative adverse events.ResultsCompared with the control group, our modified strategy significantly increased the optimal and acceptable position rate (76% vs 98%, respectively; p<0.039), decreased the replacement rate (80% vs 94%; p=0.042), shortened the intubation time (101.4±7.3 s vs 75.2±8.1 s; p=0.019) and reduced the incidence of transient hypoxaemia (25% vs 6%; p=0.022), subglottic resistance (20% vs 6%; p=0.037), tracheobronchial injury (35% vs 13%; p=0.037) and postoperative RUL collapse (15% vs 2%; p=0.059).ConclusionThis study demonstrates the superiority of our strategy and provides a new viable method for R-DLT placement.Trial registration numberChinese Clinical Trial Registry (ChiCTR1900021676).

Project description:BackgroundA fiberoptic bronchoscope (FOB) is commonly used to identify the proper placement of a double-lumen endotracheal tube (DLT) for good lung isolation during thoracic surgery. We hypothesized that the FOB-guided method for DLT placement composed of tracheal intubation under initial guidance by a FOB via the bronchial lumen and subsequent selective left-bronchial intubation could be used to reduce the incidence of DLT malposition and reduce the time required for completion of DLT placement and confirmation of proper DLT position during intubation using a left-sided DLT, in comparison to the conventional method under direct laryngoscopy using a Macintosh laryngoscope.Methods/designIn this randomized controlled pilot trial, 50 patients, aged 18-70 years, scheduled for elective thoracic surgery will be recruited and randomly assigned to two groups according to the method of DLT placement: a FOB-guided method (F) group and a conventional method (C) group. Regardless of the group, the DLT placement processes will be followed by subsequent confirmation processes, using a FOB. If the DLT is misplaced, the position would be corrected. The primary outcome is the incidence of DLT malpositioning observed via a FOB during confirmation after DLT placement. The secondary outcomes consist of the time required to achieve the entire DLT intubation process, which is the sum of the duration of DLT placement and the duration of confirmation of the proper position, the incidence of failed tracheal intubation on the first and second attempt, and complications associated with the intubation process.DiscussionThis pilot study was designed as the first randomized controlled trial to confirm our hypothesis. This should provide information for a further full-scale trial, and the outcomes of the study should provide clinical evidence on the usefulness of the FOB-guided method for DLT placement, in comparison to the conventional method.Trial registrationClinical Research Information Service; CRIS, ID: KCT0002663 . Retrospectively registered on 24 January 2018.

Project description:BackgroundThe use of a video-assisted laryngoscope (VL) has been shown to reduce the time to achieve intubation with a double-lumen endobronchial tube (DLT). As the blade of the VL is curved differently to a standard laryngoscope, the DLT must be angled into a hockey stick shape to fit properly. We conducted a study to establish which direction of angulation was best to facilitate correct positioning of the DLT when using a VL.MethodsWe enrolled patients scheduled for thoracic surgery who required intubation with a DLT. They were prospectively randomized into one of two groups: those intubated with a DLT angled to conceal the tracheal orifice (the tracheal orifice-covered, TOC) group or the tracheal orifice-exposed (TOE) group. The composite primary outcome measures were time taken to intubate and the frequency of first-time success. The time taken to intubate was divided into: T1, the time from mouth opening to visualization of the vocal cords with the VL; and T2, the time taken to advance the DLT through the cords until its tip lay within the trachea and three carbon dioxide waveforms had been detected by capnography. The hemodynamic responses to intubation and intubation-related adverse events were also recorded.ResultsSixty-six patients completed the study, with 33 in each group. Total intubation time was significantly shorter in the TOC group (mean 30.6 ± standard deviation 2.7 seconds versus 38.7 ± 3.3 seconds, p <0.0001). T2 was also significantly shorter in the TOC group than the TOE group (27.2 ± 2.5 seconds versus 34.9 ± 3.0 seconds, p <0.0001). The severity of hoarseness on the first postoperative day and sore throat on the fourth postoperative day were significantly lower in the TOC group than the TOE group (p = 0.02 and <0.0001, respectively). The hemodynamic responses to intubation were broadly similar between the groups.ConclusionWhen placing a left-sided DLT using a VL, angling the bronchial lumen to a hockey stick shape that conceals the tracheal lumen saves time and ameliorates the severity of post-intubation complications.Trial registrationClinicalTrials.gov Identifier: NCT01605591.

Dataset Information

A novel combined approach to placement of a double lumen endobronchial tube using a video laryngoscope and fiberoptic bronchoscope: a retrospective chart review.

Background

Methods

Results

Conclusion

Publications

A novel combined approach to placement of a double lumen endobronchial tube using a video laryngoscope and fiberoptic bronchoscope: a retrospective chart review.

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