Bronchial Blocker Versus Left Double-Lumen Endotracheal Tube for One-Lung Ventilation in Right Video-Assisted Thoracoscopic Surgery

Abstract

Objective: The aim of this study was to compare the quality of lung deflation of a left-sided double-lumen endotracheal tube (DLT) with a bronchial blocker (BB) for one-lung ventilation in video-assisted thoracic surgery (VATS).

Design: A prospective, randomized, clinical study.

Setting: A university-affiliated teaching hospital.

Participants: Forty-five adult patients undergoing esophageal tumor surgery using VATS with right lung deflation.

Interventions: Patients were assigned by a computer-generated randomization sequence to either the left-sided DLT or BB group. The correct positioning of the airway device was confirmed using fiberoptic bronchoscopy.

Measurements and main results: The variables assessed included: (1) time required to correctly place the devices and to achieve lung collapse; (2) the number of times the device malpositioned; (3) the quality of lung deflation as rated by the surgeon; (4) blood pressure and heart rate at baseline (T₁), immediately before (T₂) and after (T₃) and 1 minute (T₄) after intubation; (5) the number of patients with hypoxemia (SpO₂ < 90%) during the one-lung ventilation (OLV) period; and (6) postoperative hoarseness of voice, sore throat, or pulmonary infection. Of the 45 patients approached for the study, 21 patients in the DLT group and 19 patients in the BB group were analyzed. The time required to place the device in the correct position was similar between the 2 groups. The time to achieve right lung collapse in the BB group was significantly longer (mean difference: 3.232, 95% confidence interval [CI]: 1.993-4.471; p = 0.003). The quality of lung collapse, OLV duration, number of patients with device malposition, and hypoxemia in both groups were similar. There were more patients suffering hoarseness (odds ratio [OR]: 4.85, 95% CI: 1.08-21.76; p = 0.034) or sore throat (OR: 4.29, 95% CI: 1.14-16.18; p = 0.030) in the DLT group, while no patients developed postoperative lung infection in either group. Compared to T₁, systolic blood pressure (sBP), diastolic BP (dBP), and heart rate (HR) at T₂ in both groups were higher (p < 0.05) in the DLT group. Then, compared to T₂, sBP and dBP at T₃ and T₄ and HR at T₃ in the DLT group were higher (p < 0.05).

Conclusions: The results of this study showed that BB is an effective alternative for left one-lung ventilation in right VATS, but requires a longer time to achieve complete lung collapse. Moreover, the use of BB caused less hemodynamic perturbation and can reduce postoperative hoarseness and sore throat.

Keywords: bronchial blockers; complications; double-lumen tubes; one-lung ventilation; thoracic surgery.