The use of a bronchial blocker compared with a double-lumen tube for single-lung ventilation during minimally invasive direct coronary artery bypass surgery

Abstract

Objective: To investigate whether a bronchial blocker (BB) placed through a routinely used single-lumen tube (SLT) to achieve 1-lung ventilation is appropriate in patients undergoing a minimally invasive direct coronary artery bypass (MIDCAB) operation. Design: Clinical trial. Setting: University hospital. Participants: Patients scheduled for elective MIDCAB operation (n = 159). Interventions: Group A was treated with a left-sided double-lumen tube (DLT) and served as the control group. Group B was intubated with a routinely used SLT in combination with a BB. Measurements and Main Results: The following data were collected: (1) time required for placement of each tube, (2) ventilation pressures, (3) lung compliance, (4) dislocations of the DLT or BB, (5) effectiveness of lung collapse, and (6) PaO2 and fraction of inspired oxygen. In 4 patients (4%) of group B, the BB could not be placed within an acceptable time so that 155 patients (50 patients in group A, 105 patients in group B) were statistically analyzed. Statistically significant differences during 1-lung ventilation were found for peak and mean inspiratory pressure (p < 0.001 and p < 0.05), dynamic and static lung compliance (p < 0.05), and dynamic lung compliance change (p < 0.01). No statistical significance was found for intubation time (p > 0.05) and PaO2 and fraction of inspired oxygen (p > 0.05). Lung collapse was insufficient in 1 patient of group A (2%) and in 2 patients of group B (2%). Conclusion: To achieve 1-lung ventilation during a MIDCAB procedure, the use of a BB combined with an SLT is an appropriate technique as an alternative to the commonly used DLT. Copyright 2002, Elsevier Science (USA). All rights reserved.