Placement of VivaSight(TM) double lumen tube

Effect of the VivaSight double-lumen tube on the incidence of hypoxaemia during one-lung ventilation in patients undergoing thoracoscopic surgery: a study protocol for a prospective randomised controlled trial

INTRODUCTION

A double-lumen tube (DLT) is a traditional one-lung ventilation tool that needs to be positioned under the guidance of a fibreoptic bronchoscope or auscultation. The placement is complex, and poor positioning often causes hypoxaemia. In recent years, VivaSight double-lumen tubes (v-DLTs) have been widely used in thoracic surgery. Because the tubes can be continuously observed during intubation and the operation, malposition can be corrected at any time. However, the effect of v-DLT on perioperative hypoxaemia has been rarely reported. The aim of this study was to observe the incidence of hypoxaemia during one-lung ventilation with v-DLT and to compare the perioperative complications between v-DLT and conventional double-lumen tube (c-DLT).

METHODS AND ANALYSIS

One hundred patients planning to undergo thoracoscopic surgery will be randomised into the c-DLT group and the v-DLT group. During one-lung ventilation, both groups of patients will receive low tidal volume for volume control ventilation. When the blood oxygen saturation falls below 95%, the DLT will be repositioned and the oxygen concentration will be increased to improve the respiratory parameters (5 cm H₂O Positive end-expiratory pressure (PEEP) on the ventilation side and 5 cm H₂O CPAP (continuous airway positive pressure) on the operation side), and double lung ventilation measures will be taken in sequence to prevent a further decline in blood oxygen saturation. The primary outcomes are the incidence and duration of hypoxaemia and the number of intraoperative hypoxaemia treatments, and the secondary outcomes will be postoperative complications and total hospitalisation expenses.

ETHICS AND DISSEMINATION

The study protocol was approved by the Clinical Research Ethics Committee of The First Affiliated Hospital, Sun Yat-sen University (2020-418) and registered at the Chinese Clinical Trial Registry (http://www.chictr.org.cn). The results of the study will be analysed and reported.

TRIAL REGISTRATION NUMBER

ChiCTR2100046484.

[Application and Research Progress of Video Double-lumen Tube in Thoracic Surgery]

The rapid development and promotion of minimally invasive thoracic surgery represented by video-assisted thoracoscopy surgery has gradually replaced traditional thoracic surgery technique as the primary choice for the treatment of pulmonary nodules, including early lung cancer. With the clinical application of double-lumen bronchial catheters, the realization of one-lung ventilation technology not only provides a solid anesthesia foundation for the popularization of minimally invasive thoracic surgery, but also provides a guarantee for the rapid and smooth implementation of the operation. However, compared with single-lumen bronchial catheters, the diameter of the double-lumen bronchial catheter is thicker, and the tube body is hard and difficult to shape, which brings inconvenience to anesthesia intubation. The bronchial structure is different, and the incidence of dislocation during anesthesia intubation is also high. With the gradual clinical use of video double-lumen tube (VDLT), it has become a hot spot in thoracic surgery in recent years. This article reviews the application and research progress of VDLT in thoracic surgery.
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Evaluation of time to intubation and rate of success for different healthcare professionals using a double-lumen left-sided endotracheal video tube: A prospective observational study

Intubation with a double-lumen left-sided endotracheal video tube has been the standard procedure for nearly five years in the Department of Cardiothoracic Surgery, Copenhagen University Hospital, but no systematic evaluations have been done. For a 12-month period ending November 2017, data were collected from 579 consecutive patients, scheduled for thoracic surgery with a requirement for one-lung ventilation; 35 anaesthetist trainees (nurses or doctors) (287 cases), 27 nurse anaesthetists (239 cases) and 8 anaesthesiologists (53 cases) managed intubation with a double-lumen tube. Time to intubation was relatively equal across healthcare professionals with a mean time of 53 (anaesthetist trainees), 40 (nurse anaesthetists) and 63 (anaesthesiologists) seconds. The shorter time for nurse anaesthetists and prolonged time for anaesthesiologists might be due to the small number of cases and the fact that anaesthesiologists carried out 60% of the cases, where a third attempt was needed, and 25% of cases for the anaesthesiologists were assessed to a Cormack-Lehane grade of 3 or 4 compared to 6% for anaesthetist trainees and 5% for nurse anaesthetists. The rate of successful placement in the first attempt of placing the double-lumen left-sided endotracheal video tube was high, which emphasises that intubation with a double-lumen left-sided endotracheal video tube is suitable for use by different healthcare professionals.