Disconnection Technique With a Bronchial Blocker for Improving Lung Deflation

Ajou University School of Medicine

Status: Completed

Conditions: Pneumothorax

Treatments: Procedure: BB with conventional technique; Procedure: Disconnection technique; Procedure: DLT with conventional technique

Study type: Interventional

Funder types: Other

Identifiers

NCT01846936

AJIRB-DEV-DE1012-001

Details and patient eligibility

About

One lung ventilation (OLV) is accomplished with a double lumen tube (DLT) or a bronchial blocker (BB). In this study, the investigators compared the effectiveness of lung collapse using DLT, BB with spontaneous collapse, and BB with disconnection technique.

Full description

In selecting this maneuver of OLV, lung collapse is a major concern because it permits adequate surgical exposure. Although once lung deflation was achieved, the overall clinical performance appears to be similar, BB takes longer to deflate the operative lung and there is some conflict reports as to BB provides a similar degree of lung deflation compared to that of DLT.

The aim of this study was to compare the efficacy of BB and DLT for achieving lung collapse, and to evaluate the efficacy of disconnection technique with monitoring the carbon dioxide trace on a capnograph in BB. The investigators further evaluated the disconnection time, which is the time to loss of carbon dioxide trace on the capnograph, needed to facilitate lung collapse.

Enrollment: 54 patients

Sex: All

Ages: 16+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Patients undergoing thoracic surgery for which OLV is required

Exclusion criteria

• Patients with an anticipated difficult intubation with infectious or bleeding lung lesions are excluded.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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54 participants in 3 patient groups

DLT with conventional technique

Experimental group

Description:

The double lumen tube is introduced into the glottis under direct laryngoscopy. After the bronchial cuff had passes the vocal cords, the tube is rotated counterclockwise 90° and advanced until a slight resistance was encountered. One lung ventilation is initiated after the lumen of operative lung is clamped and opened.

Treatment:

Procedure: DLT with conventional technique

BB with conventional technique

Active Comparator group

Description:

The brochial blocker (BB) is introduced through the endotracheal tube to the desired bronchus under fiberoptic bronchoscopy (FOB) vision by turning the device's steering wheel. The BB cuff is inflated with air under FOB vision with the volume necessary to seal the bronchus and initiate one lung ventilation. And then, dependent lung is ventilated.

Treatment:

Procedure: BB with conventional technique

Disconnection technique

Active Comparator group

Description:

Disconnection technique; 1) before initiating OLV, we turned-off the ventilator and fully opened the adjustable pressure limiting valve allowing both lungs to collapse, and 2) after loss of the carbon dioxide trace on the capnograph, 3) inflated the BB cuff with air, and 4) turned-on the ventilator allowing only dependent-lung reventilation.

Treatment:

Procedure: Disconnection technique