IS THERE A BETTER RIGHT-SIDED TUBE FOR ONE LUNG VENTILATION?

Abstract

S534 INTRODUCTION: Anatomic variations between the tracheal carina and take off of the right upper bronchus (RUB) make the use of right-sided double lumen tubes (R-DLT) or right Univent bronchial blockers (R-UBB) undesirable. Right DLT have shown a low margin of safety due to obstruction of the RUB, or poor collapse of the right upper lobe [1]. Right-UBB will produce similar results, however there are no reports comparing the use of R-DLT vs R-UBB for right side thoracic surgery. METHODS: After approval from the Human Subjects Review Committee, 24 patients (18 males and 6 females) having right sided thoracic surgery procedures were studied in a randomized fashion after assignment to one of two groups. Twelve patients received a R-DLT, and 12 patients received R-UBB. The following events were recorded after tube placement, and with fiber optic bronchoscopy (FOB) confirmation under general anesthesia in the supine and then the lateral position. 1) Time spent to achieve optimal position; 2) Number of malpositions-assessed every 30 mins.; 3) Effective lung collapse-assessed every 30 mins. by a surgeon blinded to tube assignment; excellent (total collapse), fair (fair collapse), and poor (no collapse), 4) Time to lung collapse, 5) Number of FOB required to assure proper position; and 6) cost of tubes. Values are expressed as mean +/- SD. The positioning time, number of FOB, and time to lung collapse were analyzed using the Wilcoxon 2 sample test. Number of malpositions was analyzed using the Fisher exact test. P value <0.05 was used for statistical significance. RESULTS: Table I shows the results for positioning time in minutes, time to lung collapse in minutes, and number of FOB. Table II shows the number of malpositions. In the R-DLT group 1/12 patients, and in the R-UBB 2/12 patients experienced malpositions. All malpositions once identified were corrected. Exposure was ranked as excellent in 12/12 patients in both the R-DLT and R-UBB groups.Table ITable IIDISCUSSION: This study demonstrates that either tube can be used for right-sided thoracic surgery. Also, this investigation refutes a previous study suggestion that R-DLT should be avoided [1]. Reasons for improvement in positioning include: R-DLT-use of FOB in supine and lateral decubitus positions and visualization of blue cuff at the entrance of right mainstream bronchus. R-UBB; suctioning the RUB with the FOB prior to inflation of the bronchial blocker. In summary, both tubes proved to be safe for right thoracic procedures with cost higher for R-UBB.