COMPARISON OF A MODIFIED DOUBLE-LUMEN ENDOTRACHEAL-TUBE WITH A SINGLE-LUMEN TUBE WITH ENCLOSED BRONCHIAL BLOCKER

This study compared the modified BronchoCath(R) double-lumen endotrach eal tube with the Univent(R) bronchial blocker to determine whether th ere were objective advantages of one over the other during anesthesia with one-lung ventilation (OLV). Forty patients having either thoracic or esophageal procedures were randomly assigned to one of two groups. Twenty patients received a left-side modified BronchoCath(R) double-l umen tube (DLT), and 20 received a Univent(R) tube with a bronchial bl ocker. The following were studied: 1) time required to position each t ube until satisfactory placement was achieved; 2) number of times that the fiberoptic bronchoscope was required; 3) frequency of malposition s after initial placement with fiberoptic bronchoscopy; 4) time requir ed until lung collapse; 5) surgical exposure ranked by surgeons blinde d to type of tube used; and 6) cost of tubes per case. No differences were found in: 1) time required to position each tube (DLT 6.2 +/- 3.1 versus Univent(R) 5.4 +/- 4.5 min [mean +/- SD]); 2) number of bronch oscopies per patient (DLT median 2, range 1-3 versus Univent(R) median 3, range 2-5); or 3) time to lung collapse !BLT 7.1 +/- 5.4 versus Un ivent(R) 12.3 +/- 10.5 min). The frequency of malposition was signific antly lower for the DLT (5) compared to the Univent(R) (15) (P < 0.003 ). Blinded evaluations by surgeons indicated that 18/20 DLT provided e xcellent exposure compared to 15/20 for the Univent(R) group (P = not significant). We conclude that in spite of the greater frequency of ma lposition seen with the Univent(R), once position was corrected adequa te surgical exposure was provided. In the Univent(R) group the inciden ce of malposition and cost involved were both sufficiently greater tha t we cannot find cost/ efficacy justification for routine use of this device.