EZ Blocker Versus Left Sided Double-lumen Tube

Radboud University Medical Center

Status and phase: Completed; Phase 4

Conditions: One-lung Ventilation

Treatments: Device: Placement of EZ- Blocker for one-lung ventilation; Device: Placement of double lumen tube for one-lung ventilation

Study type: Interventional

Funder types: Other

Identifiers

NCT01073722

NL30799,091,09

Details and patient eligibility

About

Lung isolation is used to achieve one lung ventilation to facilitate thoracic surgery. Two methods are commonly used, a double lumen tube (DLT) or a bronchial blocker introduced through a single lumen tube. However, both techniques have advantages and disadvantages. Briefly, the DLT can be positioned faster and remains firmly in place, but is sometimes difficult or even impossible to introduce. The DLT is larger than a conventional single lumen tube and the incidence of postoperative hoarseness and airway injuries is higher. Compared to the DLT, bronchial blocking devices are more difficult to position and need more frequent intraoperative repositioning. These disadvantages of the existing devices for lung isolation prompted further development of the bronchial blocker concept. The design of a new Y shaped bronchial blocker, the EZ- Blocker® (AnaesthetIQ BV, Rotterdam, The Netherlands) (EZB), combines the advantages of both lung isolation techniques. The aim of the study is to compare in a randomised, prospective way the ease of placement, the incidence of malpositioning and the quality of lung deflation of a left DLT and a EZB. Secondly, the incidence and severity of damage to laryngeal, tracheal and bronchial structures caused by the use of the DLT or the EZB is a target of the study.

Enrollment: 100 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• ASA physical status 1-3 patients
• Patients scheduled for surgery requiring a left sided DLT for single lung ventilation

Exclusion criteria

• Contraindications are lesions along the path of the left sided double lumen tube or the EZB
• Tracheal or mainstem bronchial stenosis
• Distorted carinal anatomy,
• Anticipated difficult intubation (Mallampatti score ≥ 3)
• History or presence of tracheostoma
• Patients who require absolute lung separation
• Patients who require sleeve resection of mainstem bronchus

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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100 participants in 2 patient groups

Left double lumen tube

Active Comparator group

Description:

Traditionally, single lung ventilation is obtained with a double lumen tube (DLT). In our institution a polyvinyl DLT (Broncho-cath, Mallinckrodt,) without carinal hook, is used. This type of tube exists of a tube with two lumen with two distal cuffs. One lumen (called the bronchial lumen) extends some distance further, has a slight curvature and has a small blue cuff. The other lumen (called the tracheal lumen) has a larger cuff. A DLT tube exists in four sizes and one can choose in a left or a right configuration. Almost always, we use a left sided DLT. A DLT has a much larger diameter than a standard single lumen endotracheal tube

Treatment:

Device: Placement of double lumen tube for one-lung ventilation

EZ-blocker

Active Comparator group

Description:

The EZ-blocker (EZB) is a semi-rigid catheter but it has two distal extensions, both with an inflatable cuff and a central lumen. It is intended for use in combination with a standard single lumen tube. After the EZB is advanced trough the distal end of the single lumen tube, both extensions spread out and find their way in the left and right main stem bronchi. The place where the two extensions are attached to the shaft now rests on the carina. Fiber optic bronchoscopy should be used for proper positioning. After placement of the EZB, one of the cuffs can be inflated to obtain lung separation under direct visual inspection with fiber optic bronchoscopy.

Treatment:

Device: Placement of EZ- Blocker for one-lung ventilation