title: Bronchial blocker versus left double-lumen endotracheal tube in video-assisted thoracoscopic surgery: a randomized-controlled trial examining time and quality of lung deflation.
abstract: BACKGROUND
  Double-lumen endotracheal tubes (DL-ETT) and bronchial blockers (BB) have both been used for lung isolation in video-assisted thoracic surgery (VATS). Though not well studied, it is widely thought that a DL-ETT provides faster and better quality lung collapse. The aim of this study was to compare a BB technique vs a left-sided DL-ETT strategy with regard to the time and quality of lung collapse during one-lung ventilation (OLV) for elective VATS.
  
  
  METHODS
  Forty patients requiring OLV for VATS were randomized to receive a BB (n = 20) or a left-sided DL-ETT (n = 20). The primary endpoint was the time from pleural opening (performed by the surgeon) until complete lung collapse. The time was evaluated offline by reviewing video recorded during the VATS. The quality of lung deflation was also graded offline using a visual scale (1 = no lung collapse; 2 = partial lung collapse; and 3 = total lung collapse) and was recorded at several time points after pleural incision. The surgeon also graded the time to complete lung collapse and quality of lung deflation during the procedure. The surgeon's guess as to which device was used for lung isolation was also recorded.
  
  
  RESULTS
  Of the 40 patients enrolled in the study, 20 patients in the DL-ETT group and 18 in the BB group were analyzed. There mean (standard deviation) time to complete lung collapse of the operative lung was significantly faster using the BB compared with using the DL-ETT [7.5 (3.8) min vs 36.6 (29.1) min, respectively; mean difference, 29.1 min; 95% confidence interval, 1.8 to 7.2; P < 0.001]. Overall, a higher proportion of patients in the BB group than in the DL-ETT group achieved a quality of lung collapse score of 3 at five minutes (57% vs 6%, respectively; P < 0.004), ten minutes (73% vs 14%, respectively; P = 0.005), and 20 min (100% vs 25%, respectively; P = 0.002) after opening the pleura. The surgeon incorrectly guessed the type of device used in 78% of the BB group and 50% of the DL-ETT group (P = 0.10).
  
  
  CONCLUSIONS
  The time and quality of lung collapse during OLV for VATS was significantly better when using a BB than when using a left-sided DL-ETT. Surgeons could not reliably determine which device was being used based on the time and quality of lung collapse. This trial was registered at ClinicalTrials.gov number, NCT01615263.
authors.affiliation: Department of Anesthesiology, IUCPQ-UL, Quebec City, QC, Canada. jbuss@criucpq.ulaval.ca.|Research Centre, IUCPQ-UL, Quebec City, QC, Canada. jbuss@criucpq.ulaval.ca.|Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, 2725, Chemin Sainte-Foy, Quebec City, QC, G1V 4G5, Canada. jbuss@criucpq.ulaval.ca.
authors.forename: Jean S
authors.initials: JS
authors.lastname: Bussières
authors.affiliation: Department of Anesthesiology, IUCPQ-UL, Quebec City, QC, Canada.
authors.forename: Jacques
authors.initials: J
authors.lastname: Somma
authors.affiliation: Department of Anesthesiology, IUCPQ-UL, Quebec City, QC, Canada.
authors.forename: José Luis Carrasco
authors.initials: JL
authors.lastname: Del Castillo
authors.affiliation: Department of Anesthesiology, IUCPQ-UL, Quebec City, QC, Canada.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Lemieux
authors.affiliation: Department of Thoracic Surgery, IUCPQ-UL, Quebec City, QC, Canada.
authors.forename: Massimo
authors.initials: M
authors.lastname: Conti
authors.affiliation: Department of Thoracic Surgery, IUCPQ-UL, Quebec City, QC, Canada.
authors.forename: Paula A
authors.initials: PA
authors.lastname: Ugalde
authors.affiliation: Research Centre, IUCPQ-UL, Quebec City, QC, Canada.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Gagné
authors.affiliation: Pneumology Center, IUCPQ-UL, Quebec City, QC, Canada.
authors.forename: Yves
authors.initials: Y
authors.lastname: Lacasse
mesh_terms: D001980:Bronchi / Q000503:physiopathology*; D004867:Equipment Design; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation* / Q000379:methods; D008297:Male; D008875:Middle Aged; D061810:One-Lung Ventilation / Q000295:instrumentation* / Q000379:methods*; D011446:Prospective Studies; D001261:Pulmonary Atelectasis / Q000503:physiopathology; D016037:Single-Blind Method; D020775:Thoracic Surgery, Video-Assisted / Q000295:instrumentation / Q000379:methods*; D013997:Time Factors