title: Thoracic ultrasound confirmation of correct lung exclusion before one-lung ventilation during thoracic surgery.
abstract: BACKGROUND
  Fiberoptic bronchoscopy is the standard method for verifying the correct position of a double-lumen endotracheal tube (DLET) prior to one-lung ventilation. However, it must be performed by a specially trained anesthesiologist and is often resource consuming. The aim of this study was to compare this approach with thoracic ultrasound done by a nurse anesthetist in terms of sensitivity, specificity, and cost-effectiveness.
  
  
  METHODS
  We conducted a prospective cross-over case-control study involving 51 adult patients consecutively undergoing thoracic surgery with one-lung ventilation. After orotracheal intubation with a DLET, correct exclusion of the lung being operated on exclusion was assessed first by a certified anesthesiologist using standard fiberoptic bronchoscopy and then by a trained nurse anesthetist using thoracic ultrasound. The nurse was blinded as to the findings of the anesthesiologist's examination.
  
  
  RESULTS
  The two approaches proved to be equally sensitive and specific, but the ultrasound examination was more rapid. This factor, together with the fact that ultrasound was performed by a nurse instead of a physician, and the costs of materials and sterilization, had a significant economic impact amounting to a net saving of €37.20 ± 5.40 per case.
  
  
  CONCLUSIONS
  Although fiberoptic bronchoscopy is still the gold standard for checking the position of a DLET, thoracic ultrasound is a specific, sensitive, cost-effective alternative, which can be used to rapidly verify the proper function of the tube based on the demonstration of correct lung exclusion.
authors.affiliation: Anesthesia Service, Bellinzona Regional Hospital, 6500 Bellinzona, Switzerland.
authors.forename: Andrea
authors.initials: A
authors.lastname: Saporito
authors.affiliation: Anesthesia Service, Bellinzona Regional Hospital, 6500 Bellinzona, Switzerland.
authors.forename: Antonio
authors.initials: A
authors.lastname: Lo Piccolo
authors.affiliation: Anesthesia Service, Bellinzona Regional Hospital, 6500 Bellinzona, Switzerland.
authors.forename: Daniele
authors.initials: D
authors.lastname: Franceschini
authors.affiliation: Anesthesia Service, Bellinzona Regional Hospital, 6500 Bellinzona, Switzerland.
authors.forename: Renato
authors.initials: R
authors.lastname: Tomasetti
authors.affiliation: Anesthesia Service, Bellinzona Regional Hospital, 6500 Bellinzona, Switzerland.
authors.forename: Luciano
authors.initials: L
authors.lastname: Anselmi
keywords: Anesthesia; Thoracic surgery; Thoracic ultrasound