A Retrospective Evaluation of the Use of Video-Capable Double-Lumen Endotracheal Tubes in Thoracic Surgery

• Published in: Journal of cardiothoracic and vascular anesthesia 2014-08, Vol.28 (4), p.870-872
• Main Authors: Heir, Jagtar Singh, DO, Purugganan, Ron, MD, Jackson, Timothy A., MD, PhD, Norman, Peter H., MD, Cata, Juan P., MD, Kosturakis, Alyssa, BA, Thakar, Dilip, MD
• Format: Article
• Language: English
• Subjects: Aged; Anesthesia & Perioperative Care; Bronchoscopy - methods; Critical Care; double-lumen tubes; Equipment Design; Female; Fiber Optic Technology; fiberoptic bronchoscopy; fiberoptics; Humans; Intubation, Intratracheal - instrumentation; Male; Middle Aged; one-lung ventilation; Respiration, Artificial - methods; Retrospective Studies; thoracic anesthesia; thoracic surgery; Thoracic Surgical Procedures; Video Recording - instrumentation; video-double-lumen endobronchial tube
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2013.11.011

Objective The objective of this study was to evaluate whether the use of a video double-lumen tube reduced the need for fiberoptic bronchoscopy for (1) verification of initial tube placement and for (2) reverification of correct placement after repositioning for thoracotomy. Design A single-center retrospective study. Setting Thoracic surgery in a medical university hospital. Participants & Interventions After institutional review board approval, 29 patients who underwent thoracic surgical procedures using video double-lumen tubes were included in the final retrospective analysis. Measurements and Main Results For 27 (93.2%) patients, the use of fiberoptic bronchoscopy was not needed either for initial placement or for verification of correct video double-lumen tube placement upon final positioning of the patient. However, for two patients, fiberoptic bronchoscopy was needed: for (1) one patient with severe left mainstem bronchus distortion as a result of a large left upper lobe tumor, and (2) a second patient with secretions that were difficult to clear. Conclusion This study demonstrates that the video double-lumen tube requires significantly less (6.8%) fiberoptic use for both initial placement and verification of final position, in stark contrast to standard practice in which bronchoscopy is always used to verify final positioning of the double-lumen tube. As opposed to intermittent bronchoscopy, the continuous visualization offered by an embedded camera may confer an added measure of safety.