A Randomized Controlled Study of the Use of Video Double-Lumen Endobronchial Tubes Versus Double-Lumen Endobronchial Tubes in Thoracic Surgery

Objective To compare the incidence of fiberoptic bronchoscope (FOB) use (1) during verification of initial placement and (2) for reconfirmation of correct placement following repositioning, when either double lumen tube (DLT) or video double lumen tube (VDLT) was used for lung isolation during thoracic surgery. Design A Randomized Controlled Study. Setting Single center university teaching hospital. Participants The study comprised of 80 patients who were 18 years or older requiring lung isolation for surgery. Interventions After IRB approval, patients were randomized prior to surgery, to either DLT or VDLT usage. Attending anesthesiologists placed the MallinckrodtTM DLT or VivasightTM VDLT with conventional laryngoscopy or video-laryngoscopy, then verified correct tube position through the view provided with either VDLT external monitor or FOB. Measurements and Main results Data collected included: gender, BMI, successful intubation and endobronchial placement, intubation time, confirmation time of tube position, FOB use, quality of view, dislodgement of tube and ability to forewarn dislodgement of endobronchial cuff and complications. FOB use for verification of final position of the tube {VDLT 13.2%(5/38) versus DLT 100%(42/42), p-value<0.0001}, need for FOB to correct the dislodgement {VDLT 7.7%(1/13) versus DLT 100%(14/14), p-value<0.0001}, dislodgement during positioning {VDLT 61.5%(8/13) versus DLT 64.3%(9/14), p=ns}, dislodgement during surgery {VDLT 38.5%(5/13) versus DLT 21.4%(3/14), p=ns}, ability to forewarn dislodgement of endobronchial cuff {VDLT 18.4%(7/38) versus DLT 4.8%(2/42), p-value=0.078}. Conclusion This study demonstrated a reduction of 86.8% in FOB use, which is a similar reduction found in other published studies.