Endobronchial intubation with a traditional double-lumen tube is often used for thoracic procedures requiring lung isolation (DLT). Despite the fact that single-lumen tubes and bronchial blockers are also used to separate the lungs, DLTs continue to be the most common and prominent procedure. In order to provide effective anesthesia administration during thoracic surgical operations, DLTs must be inserted correctly. A misplaced tube often results in hypoventilation, insufficient lung collapse, and an increased risk for postoperative respiratory infections. Blind intubation of the bronchus alone has been observed to be inaccurate in 32 to 48 percent of instances.
Auscultation, point-of-care ultrasonography, and breathing pressures may be utilized to assess the proper placement of DLTs, but they are inadequate to prove the effectiveness of selective bronchial intubation. Moreover, the lateral decubitus posture of the patient during the surgical process might result in bronchial extubation or pulmonary blockage, which can severely impair breathing and operation success. Consequently, fiberoptic bronchoscopy with a flexible fiberscope is the gold standard for guiding the endobronchial channel into position and confirming proper placement under direct visualization.
An integrated high-resolution camera is located at the end of the tracheal lumen of the VivaSight double-lumen tube (VDLT), which provides real-time views of the airway during intubation of the trachea and bronchus and during lung surgery. Continuous imaging of the carina is a significant benefit for patient care since intraoperative displacement may be identified and corrected quickly.
The purpose of this research was to collect intraoperative and immediate postoperative data on patients having thoracic surgery while utilizing the VDLT or cDLT for intubation and airway management during lung isolation operations.
A random sample of 100 patients who had lung resection throughout the study period was chosen to compare 50 patients in the VDLT group with 50 patients in the cDLT group. The major objective of the research was to determine whether fiberoptic bronchoscopy was required to validate the proper placement of VDLT or cDLT utilized for lung isolation. Secondary outcomes were respiratory parameters, ICU admission, hospitalization time, surgical complications, readmission, and 30-day death rate. The VDLT group used fiberoptic bronchoscopy less often, and the size of the tube was smaller. The intraoperative parameters for respiration and hemodynamics were excellent. There were no additional differences between the groups preoperatively, intraoperatively, or postoperatively.
Patients undergoing lung resection who were intubated with the VDLT device required significantly less fiberoptic bronchoscopy to assess tube positioning during surgery compared to patients intubated with the cDLT device (9 patients [18%] vs. 26 patients [52%), and this difference was statistically significant. The current research offers further evidence that the VDLT device reduces the proportion of patients needing bronchoscopy, but fiberoptic bronchoscopy remains the gold standard for confirming accurate tube location.
Contrariwise, good visibility and constant monitoring of the airway given by the high-resolution camera enable quick correction and avoidance of problems of a poorly positioned tube, such as lobar collapse, hypoxemia, and/or postoperative pulmonary infections. VivaSight has a quicker tracheal intubation rate and a greater success rate on the first try, according to studies comparing VDLT to traditional DLT. In addition, several studies have shown that VDLT achieves intubation quicker and with a greater success rate than cDLT assessed by fiberscope in both normal and difficult airway settings.
It has been shown that the use of smaller VDLT calibers relative to cDLT is a safe therapeutic practice with regard to airway control, ventilation, and incidence of complications.The usage of VDLT is cost-effective, regardless of whether disposable or reusable fiberscopes are used to verify the precise location of the double-lumen tube.
Granell M, Petrini G, Kot P, Murcia M, Morales J, Guijarro R, de Andrés JA. Intubation with vivasight double-lumen tube versus conventional double-lumen tube in adult patients undergoing lung resection: A retrospective analysis. Ann Card Anaesth 2022;25:279-85
Dr Monish Raut is a practising Cardiothoracic-Vascular Anesthesiologist. His clinical work is also enriched with his numerous academic publications in various national and international indexed journals. He has a keen interest in latest medical researches and updates particularly in critical care medicine, cardiology and anaesthesiology.