Disconnection technique with a bronchial blocker for improving lung deflation: a comparison with a double-lumen tube and bronchial blocker without disconnection.

Abstract

OBJECTIVE: One-lung ventilation (OLV) is accomplished with a double-lumen tube

(DLT) or a bronchial blocker (BB). The authors compared the effectiveness of lung

collapse using DLT, BB, and BB with the disconnection technique. DESIGN:

Prospective, randomized, blind trial. SETTING: A university hospital.

PARTICIPANTS: Fifty-two patients undergoing elective pneumothorax surgery.

INTERVENTIONS: Patients were assigned randomly to 1 of 3 groups: The DLT group

(group 1), the BB group (group 2), and the BB with the disconnection technique

group (group 3). The authors modified the disconnection technique in group 3 as

follows: (1) turned off the ventilator and opened the adjustable

pressure-limiting valve, allowing both lungs to collapse and (2) after loss of

the CO2 trace on the capnograph, inflated the blocker cuff and turned on the

ventilator, allowing only dependent-lung ventilation. MEASUREMENTS AND MAIN

RESULTS: Five and ten minutes after OLV, the degree of lung collapse was assessed

by the surgeon, who was blinded to the isolation technique. The quality of lung

collapse at 5 and 10 minutes was significantly better in groups 1 and 3 than in

group 2. No significant differences were observed for the degree of lung collapse

at any time point between groups 1 and 3. The average time for loss of the CO2

trace on the capnograph was 32.3+/-7.0 seconds in group 3. CONCLUSIONS: A BB with

spontaneous collapse took longer to deflate and did not provide equivalent

surgical exposure to the DLT. The disconnection technique could be helpful to

accelerate lung collapse with a BB.