Disconnection technique with a bronchial blocker for improving lung deflation: a comparison with a double-lumen tube and bronchial blocker without disconnection.
OBJECTIVE
One-lung ventilation (OLV) is accomplished with a double-lumen tube (DLT) or a bronchial blocker (BB). The authors compared the effectiveness of lung collapse using DLT, BB, and BB with the disconnection technique.


METHODS
Prospective, randomized, blind trial.


METHODS
A university hospital.


METHODS
Fifty-two patients undergoing elective pneumothorax surgery.


METHODS
Patients were assigned randomly to 1 of 3 groups: The DLT group (group 1), the BB group (group 2), and the BB with the disconnection technique group (group 3). The authors modified the disconnection technique in group 3 as follows: (1) turned off the ventilator and opened the adjustable pressure-limiting valve, allowing both lungs to collapse and (2) after loss of the CO2 trace on the capnograph, inflated the blocker cuff and turned on the ventilator, allowing only dependent-lung ventilation.


RESULTS
Five and ten minutes after OLV, the degree of lung collapse was assessed by the surgeon, who was blinded to the isolation technique. The quality of lung collapse at 5 and 10 minutes was significantly better in groups 1 and 3 than in group 2. No significant differences were observed for the degree of lung collapse at any time point between groups 1 and 3. The average time for loss of the CO2 trace on the capnograph was 32.3±7.0 seconds in group 3.


CONCLUSIONS
A BB with spontaneous collapse took longer to deflate and did not provide equivalent surgical exposure to the DLT. The disconnection technique could be helpful to accelerate lung collapse with a BB.
Department of Anesthesiology and Pain Medicine, Ajou University, School of Medicine, Suwon, Korea.
Ji Young
JY
Yoo
Department of Anesthesiology and Pain Medicine, Ajou University, School of Medicine, Suwon, Korea.
Dae Hee
DH
Kim
Department of Thoracic and Cardiovascular Surgery, Ajou University, School of Medicine, Suwon, Korea.
Ho
H
Choi
Department of Anesthesiology and Pain Medicine, Ajou University, School of Medicine, Suwon, Korea.
Kun
K
Kim
Department of Anesthesiology and Pain Medicine, Ajou University, School of Medicine, Suwon, Korea.
Yun Jeong
YJ
Chae
Department of Anesthesiology and Pain Medicine, Ajou University, School of Medicine, Suwon, Korea. Electronic address: anepark@hanmail.net.
Sung Yong
SY
Park
D000293:Adolescent; D000402:Airway Obstruction / Q000628:therapy*; D001999:Bronchoscopy; D004867:Equipment Design; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D008297:Male; D061810:One-Lung Ventilation / Q000295:instrumentation*; D011030:Pneumothorax / Q000601:surgery; D011446:Prospective Studies; D019616:Thoracic Surgical Procedures; D055815:Young Adult
bronchial blocker; double-lumen tube; effectiveness; one-lung ventilation