One-lung ventilation procedures are essential for most thoracic surgeries and the most common method is intubation with a conventional double lumen tube, with a bronchoscope used to verify correct placement of the tube.
Intubation and airway management during lung-isolation procedures, however, present a series of challenges for even the most experienced medical team. Double lumen tubes (DLT) can be difficult to insert and often move when a patient’s body moves, potentially compromising patient safety and prolonging surgery time.
But a single-use DLT from Ambu reduces these kinds of risks and improves efficiencies during thoracic surgery, according to a new study. The VivaSight-DL both decreases the number of bronchoscope verifications needed to ensure the tube is placed properly and eases other surgical complications.
A big reason? VivaSight’s integrated camera, which allows for continuous visualization during OLV.
Procedure using Ambu’s VivaSight-DL © Ambu, Inc.
The study—published in PharmacoEconomics-Open, a peer-reviewed Springer medical journal—was a randomized control trial conducted at a large university hospital in Denmark where about 600 one-lung ventilation (OLV) procedures are performed annually. It was funded by Ambu.
When physicians insert DLTs, they sometimes struggle with proper placement. And the DLTs can move as the operating room team shifts a patient’s position, which in turn can compromise safety and prolong surgery time. Studies have shown that malposition rates run as high as 48 percent, leading to additional time spent on repositioning and increasing the risk as well as the cost of surgery.
Visualization during OLV improves patient safety and is increasingly recommended as good clinical practice. Doctors check for correct tube placement using a fiberoptic or video-enabled bronchoscope, both after tube insertion and after changing the patient’s position to the final lateral surgical position. This, however, further increases the risk of the tube being displaced.
The study’s authors determined that the best effectiveness measure would be the number of times that fiber-optic confirmation of the tube placement during intubation or surgery was unnecessary and thus avoided. That’s because fiber-optic confirmation using a bronchoscope is both time-consuming and costly.
“Although intubation time is an indicator of the relative ease of correct tube placement, it is not a sufficient effectiveness measure,” the authors write, “as it reflects physician competences and varies greatly between patients because of differences in airway anatomy and health status.”
The study had 22 patients in the conventional DLT arm and 30 in the VivaSight-DL arm and a bronchoscope was only needed in 6.6 percent of OLV cases when using VivaSight-DL.
Since this study’s conclusions were based on the results from a single institution, further study is needed to clarify whether VivaSight-DL is cost-effective in larger or global clinical settings, the authors write.