title: A Comparison of the Efficacy and Adverse Effects of Double-Lumen Endobronchial Tubes and Bronchial Blockers in Thoracic Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials.
abstract: OBJECTIVE
  To compare the efficacy and adverse effects of using bronchial blockers (BBs) and double-lumen endobronchial tubes (DLTs).
  
  
  METHODS
  Systematic review and meta-analysis of randomized controlled trials (RCTs) comparing BBs and DLTs.
  
  
  METHODS
  Hospital units undertaking thoracic surgery
  
  
  METHODS
  Patients undergoing thoracic surgery requiring lung isolation.
  
  
  METHODS
  BBs and DLTs.
  
  
  RESULTS
  A systematic literature search was conducted for RCTs comparing BBs and DLTs using Google Scholar, Ovid Medline, and Cochrane library databases up to October 2013. Inclusion criteria were RCTs comparing BBs and DLTs, intubation carried out by qualified anesthesiologists or trainee specialists, outcome measures relating to either efficacy or adverse effects. Studies that were inaccessible in English were excluded. Mantel-Haenszel fixed-effect meta-analysis of recurring outcome measures was performed using RevMan 5 software. The search produced 39 RCTs published between 1996 and 2013. DLTs were quicker to place (mean difference: 51 seconds, 95% confidence intervals [CI] 8-94 seconds; p = 0.02) and less likely to be incorrectly positioned (odds ratio [OR] 2.70; 95% CI 1.18-6.18, p = 0.02) than BBs. BBs were associated with fewer patients having a postoperative sore throat (OR 0.39, 95% CI: 0.23-0.68, p = 0.0009), less hoarseness (OR: 0.43,95%, CI 0.24-0.75, p = 0.003), and fewer airway injuries (OR 0.40, 95% CI 0.21-0.75, p = 0.005) than DLTs.
  
  
  CONCLUSIONS
  While BBs are associated with a lower incidence of airway injury and a lower severity of injury, DLTs can be placed quicker and more reliably.
authors.affiliation: College of Medicine and Veterinary Medicine, Academic Administration, The University of Edinburgh, Edinburgh, United Kingdom. Electronic address: s1202024@sms.ed.ac.uk.
authors.forename: Ana
authors.initials: A
authors.lastname: Clayton-Smith
authors.affiliation: College of Medicine and Veterinary Medicine, Academic Administration, The University of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Kyle
authors.initials: K
authors.lastname: Bennett
authors.affiliation: College of Medicine and Veterinary Medicine, Academic Administration, The University of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Robin Peter
authors.initials: RP
authors.lastname: Alston
authors.affiliation: College of Medicine and Veterinary Medicine, Academic Administration, The University of Edinburgh, Edinburgh, United Kingdom.
authors.forename: George
authors.initials: G
authors.lastname: Adams
authors.affiliation: College of Medicine and Veterinary Medicine, Academic Administration, The University of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Greg
authors.initials: G
authors.lastname: Brown
authors.affiliation: College of Medicine and Veterinary Medicine, Academic Administration, The University of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Timothy
authors.initials: T
authors.lastname: Hawthorne
authors.affiliation: College of Medicine and Veterinary Medicine, Academic Administration, The University of Edinburgh, Edinburgh, United Kingdom.
authors.forename: May
authors.initials: M
authors.lastname: Hu
authors.affiliation: College of Medicine and Veterinary Medicine, Academic Administration, The University of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Angus
authors.initials: A
authors.lastname: Sinclair
authors.affiliation: College of Medicine and Veterinary Medicine, Academic Administration, The University of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Jay
authors.initials: J
authors.lastname: Tan
mesh_terms: D006685:Hoarseness / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D010612:Pharyngitis / Q000175:diagnosis / Q000209:etiology; D016032:Randomized Controlled Trials as Topic / Q000379:methods*; D019616:Thoracic Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D016896:Treatment Outcome
keywords: adverse effects; bronchial blocker; double-lumen endobronchial tube; efficacy; lung isolation; one-lung ventilation; thoracic surgery