Retrospective evaluation of the use of left sided double-lumen endobronchial tubes with an embedded camera VivaSight-DL® during lung separation in 30 thoracic surgery patients

Abstract

Introduction Lung isolation is essential in thoracic surgery, specially to achieve a lung resection. Left sided double-lumen endobronchial tubes with an embedded camera (VTDL) VivaSight-DL® allow the airway's management and its continuous visualization on a portable external monitor as well as one-lung isolation during anesthetics procedures1. It might be useful in thoracic surgery. Although nowadays the fiberoptic bronchoscopy (FBS) is the “gold standard” to verify the position of endobronchial tubes, the VTDL might become an alternative2. The purpose of this study is to review whether the VTDL reduces or overrides the need for FBS for verification of the endobronchial tube's placement during intubation. Methods Retrospective descriptive and longitudinal study during 14,5 months in the CHGUV for patients who underwent lung resection procedures with VTDL VivaSight-DL® for one-lung isolation. Data collected included: sex, age, body mass index, Mallampati, Cormack-Lehane, ASA risk, difficult intubation, airway's management, FBS use, VTDL size, PEEP, SpO2, FiO2, ETCO2, peak flow, hospital stay, complications, re-admission and mortality. Results 30 patients who underwent lung resection procedures using VTDL were included. The age average was 66’27± 1,65 years. The VTDL was used with direct laryngoscope. Neither of them needed FBS. The intraoperative respiratory parameters were optimal (Fig. 1. TLV: two lung ventilation, OLV: one lung ventilation). The average time of stay in ICU was 1,41 ± 0,45 days and the total hospital stay 6,23 ± 0,83 days. There was 1 re-admission in ICU, 2 in hospital and 11 complications. Survival rate was 100%. Discussion Lung isolation is very important in thoracic surgery. Left sided double-lumen endobronchial tubes with an embedded camera (VTDL) VivaSight-DL® allow the airway's management and its continuous visualization on a portable external monitor as well as one-lung isolation during anesthetics procedures1. It might be useful in thoracic surgery because some studies concludes that this device is useful to check the double lumen insertion and its displacements during the changes of position of the thoracic patients or during the thoracic surgical procedure 2. Perhaps the FBS is now no so necessary as in the past but we needed more studies to analyze this situation.