Use Of Double-lumen Endotracheal Tube Research Articles

Comparison of the effect of double-lumen endotracheal tubes and bronchial blockers on lung collapse in video-assisted thoracoscopic surgery: a systematic review and meta-analysis

ObjectiveThis meta-analysis compared the quality of lung collapse and the resultant adverse reactions between the use of double-lumen endotracheal tubes (DLT) and bronchial blockers (BB) in minimally invasive thoracic surgery.MethodsA search was performed in five bibliographic databases, namely PubMed, Springer, Medline, EMBASE, and Cochrane Library ignoring the original language, which identified five randomized controlled trials (RCTs) published on or before December 31, 2021. These studies were subsequently analyzed. All included studies compared the efficacy and safety of DLT and BB as a lung isolation technique in surgery. The methodological quality of each study was assessed by the Cochrane Collaboration’s risk of bias tool. The quality of lung collapse and the malposition rate were adopted as the main outcome indicators. Alternatively, the intubation time and the incidence of postoperative sore throat were adopted as secondary indicators.ResultsWhen either DLT or BB were utilized in minimally invasive thoracic surgery, no differences were observed in the quality of lung collapse (odds ratio [OR], 1.00; 95% confidence interval [CI], 0.63 to 1.58), the intubation time (mean difference [MD], 0.06; 95% CI, -1.02 to 1.14), or the malposition rate (OR, 0.88; 95% CI, 0.37 to 2.06). However, the incidence of postoperative sore throat among patients treated with BB was significantly lower than that among patients treated with DLT (OR, 5.25; 95% CI, 2.55 to 10.75).ConclusionWhen utilized in minimally invasive thoracic surgery, the quality of lung collapse with DLT was identical to that with BB. However, patients treated with the latter demonstrated a significantly lower incidence of postoperative sore throat.

One lung ventilation at high altitude (11600 ft) for video assisted thoracoscopic surgery (VATS) in a case of covid-19 sequela-empyema thoracis

Lung isolation for surgical facilitation by means of one lung ventilation (OLV) is seeing widespread use in all age groups due to increasing incidence of thoracoscopy and video-assisted thoracoscopic surgery (VATS). Lung isolation is most commonly achieved by use of double-lumen endotracheal tubes with or without a bronchial blocker. Development of intraoperative hypoxaemia (arterial oxygen saturation <90%) caused by OLV is a known hazard. In high altitude area (HAA), the lowered amount of O2 caused by a decrease in the barometric pressure (BP) leads to hypobaric hypoxia. Covid 19 directly impacts the lungs and damages the alveoli in the affected individuals exacerbating the hypoxia. Though rare, respiratory long-term sequelae of COVID-19 such as lung abscess can occur. The management of hypoxia in the course of lung isolation was a challenge especially in the high-altitude scenario with a Covid-19 background. The present report is of an adult male with high COVID-19 antibody titres who underwent video-assisted thoracoscopic surgery at a service hospital located in a high-altitude area (HAA) with altitude 11600 ft. One lung ventilation was performed with a 39 Fr left double lumen tube. Correct placement was confirmed with fiber optic bronchoscopy. The surgery was uneventful and the patient was electively ventilated postoperatively for 48 hrs. No complications were noted peri-operatively. The soldier was subsequently discharged for convalescence.

Intentional Occlusion of the Right Upper Lobe Bronchial Orifice to Tamponade Life-threatening Hemoptysis

Intentional Occlusion of the Right Upper Lobe Bronchial Orifice to Tamponade Life-threatening Hemoptysis

Video-assisted thoracic surgery

Thoracoscopy has assumed a major role in the management of a variety of surgical diseases of the chest. This technique, which was primarily devised for diagnostic purposes, has subsequently come to be used for therapeutic applications in most centers today. In this report we review 300 cases of therapeutic thoracic procedures in which a video-assisted technique was used. We describe mainly our own experience and the basic approach strategies we found helpful in the video-assisted procedures. No complications or deaths were attributable to these procedures. Our conclusions were as follows: (1) Video-assisted thoracic surgery can be as effective therapeutically as many formal thoracotomy. (2) Excellent exposure can be obtained by the use of double-lumen endotracheal tubes. (3) Video-assisted thoracic surgery is an excellent alternative treatment for pneumothorax, blebs, and bullous disease. (4) Video-assisted thoracic surgery allows safe, complete, visually guided wedge resection of lung lesions, lobectomy, pericardiectomy, removal of mediastinal tumor, esophagectomy, and reconstruction of the thoracic esophagus. (5) Video-assisted thoracic surgery also allows management of a broad scope of other general thoracic diseases such as empyema, pleural effusion, and chest trauma (hemothorax), as well as cancer staging. (6) Video-assisted thoracic surgery will not compromise the primary diagnostic and therapeutic goals set forth for the patient. (7) Because conventional instruments and extended manipulation incisions can be used, video-assisted thoracic surgery offers the promise of expediency, safety, minimal discomfort, less postoperative pain, quick functional recuperation, excellent cosmetic healing, shortened stays in the hospital, and therefore savings in cost. Accordingly, we are now using video-assisted thoracic surgery to treat the majority of patients with surgical diseases of the chest.

Rupture de la bronche souche gauche lors d'une intubation par sonde de Carlens

The authors report a case of left main bronchus rupture following endotracheal intubation with a Carlens double-lumen tube. The bronchus rupture occurred during a cure of gastro-œsophagcalreflux and resection of œsophageal diverticula through a left thoracotomy. The patient was a 65-year-old woman treated with corticosteroids for an Addison's disease. The weakness of the bronchial wall initiated by the steroid hormones was an important factor contributing to the perforation. There is also a higher risk of rupture during œsophageal surgery because of surgical dissection and stretch on the tracheobronchial airway. This case demonstrates that such a complication can occur without ventilatory failure. A rupture must be recognized and treated surgically very rapidly. Recommendations regarding the use of double-lumen endotracheal tubes are reviewed in order to decrease the occurrence of such a complication.