Comparison of a modified double-lumen endotracheal tube with a single-lumen tube with enclosed bronchial blocker

This study compared the modified BronchoCath[R] double-lumen endotracheal tube with the Univent[R] bronchial blocker to determine whether there were objective advantages of one over the other during anesthesia with one-lung ventilation (OLV). Forty patients having either thoracic or esophageal procedures were randomly assigned to one of two groups. Twenty patients received a left-side modified BronchoCath[R] double-lumen tube (DLT), and 20 received a Univent[R] tube with a bronchial blocker. The following were studied: 1) time required to position each tube until satisfactory, placement was achieved; 2) number of times that the fiberoptic bronchoscope was required; 3) frequency of malpositions after initial placement with fiberoptic bronchoscopy; 4) time required until lung collapse; 5) surgical exposure ranked by surgeons blinded to type of tube used; and 6) cost of tubes per case. No differences were found in: 1) time required to position each tube (DLT 6.2 +/- 3.1 versus Univent[R] 5.4 +/- 4.5 min [mean +/- SD]); 2) number of bronchoscopies per patient (DLT median 2, range 1-3 versus Univent[R] median 3, range 2-5); or 3) time to lung collapse (DLT 7.1 +/- 5.4 versus Univent[R] 12.3 +/- 10.5 min). The frequency of malposition was significantly lower for the DLT [5] compared to the Univent[R] [15] (P < 0.003). Blinded evaluations by surgeons indicated that 18/20 DLT provided excellent exposure compared to 15/20 for the Univent[R] group (P = not significant). We conclude that in spite of the greater frequency of malposition seen with the Univent[R], once position was corrected adequate surgical exposure was provided. In the Univent[R] group the incidence of malposition and cost involved were both sufficiently greater that we cannot find cost/efficacy justification for routine use of this device. (Anesth Analg 1996;83:1268-72)