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A Comparison of a Left-Sided Broncho-Cath® with the Torque Control Blocker Univent and the Wire-Guided Blocker

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Abstract

Lung isolation can be accomplished in two ways: the first, a double-lumen endotracheal tube (DLT) and the second, a bronchial blocker (Univent® or Arndt® blocker). Previous studies have found that the DLT and the Univent® are comparable when providing lung isolation. A new bronchial blocker, the wire-guided endobronchial blocker (Arndt® blocker), has been introduced. However, there is no study to report its effectiveness with lung isolation during elective thoracic surgical cases. Therefore, we designed a prospective, randomized trial to compare the effectiveness of lung isolation among the 3 endotracheal tubes: the left-sided DLT Broncho-Cath® Group A (n = 16 patients), the torque control blocker Univent® Group B (n = 16 patients), and the wire-guided Arndt® blocker Group C (n = 32 patients). The following variables were recorded: 1) time to initially position the assigned tube, 2) frequency of malpositions, 3) frequency of use of fiberoptic bronchoscope, 4) overall surgical exposure, and 5) tube acquisition cost. The Arndt® blocker took longer to place (3:34 min/s) compared with the other 2 groups: the DLT group (2:08 min/s) or the Univent® group (2:38 min/s) (P < 0.0004). There was no statistical difference in tube malpositions among the three groups: two for the DLT group, four for the Univent® group, and nine in the Arndt® group. Excluding the time for tube placement, the Arndt® group also took longer for the lung to collapse (26:02 min/s), compared with the DLT group (17:54 min/s) or Univent® group (19:28 min/s) (P < 0.0060). Furthermore, unlike the other two groups, the majority of the Arndt® patients required suction to achieve lung collapse. Once lung isolation was achieved, overall surgical exposure was rated excellent for the three groups. Acquisition cost for the DLT group was $1663.20 (21 tubes opened), $2329.00 for the Univent® group (17 tubes opened), and $3567.00 for the Arndt® group (33 wire-guided blockers opened). This study demonstrates that the Arndt® blocker takes longer to position and longer to deflate the isolated lung. For elective thoracic surgical cases, once the lung was isolated, the management seemed to be similar for all three tube groups.

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