Advantages of a New Polyvinyl Chloride Double-Lumen Tube in Thoracic Surgery

doi:10.1016/S0003-4975(10)60655-8

The Annals of Thoracic Surgery

Volume 36, Issue 1, July 1983, Pages 78-84

https://doi.org/10.1016/S0003-4975(10)60655-8 Get rights and content

Abstract

Double-lumen endobronchial tubes offer many advantages during thoracic operations. However, technical problems with tube placement and potentially life-threatening complications have discouraged widespread use of standard double-lumen tubes. Some of these problems may be reduced with a new polyvinyl chloride (PVC) double-lumen tube. A total of 214 intubations were undertaken in 204 patients using one of three endobronchial tubes. The cases of these patients were reviewed to determine differences in the complications associated with the Carlens, Robertshaw, and PVC tubes. Complications included unsuccessful or difficult intubation, tube dislodgment, unsatisfactory lung deflation, tube malposition, and hypoxemia. In 8 of 16 intubations with the Carlens tube and in 14 of 62 intubations with the Robertshaw tube, there were complications. In all, 22 of 78 intubations (28%) using conventional double-lumen tubes were complicated compared with 5 of 136 (4%) using the PVC tube. The technical problems and risks of endobronchial intubation were reduced significantly with the PVC double-lumen tube.

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Cited by (63)

Milestones in thoracic surgery
2018, Journal of Thoracic and Cardiovascular Surgery
Citation Excerpt :
Three years later, in 1931, Joseph W. Gale and Ralph M. Waters introduced a cuffed endotracheal tube that provided single lung ventilation, where the tube was advanced into one bronchus and the inflated cuff sealed another bronchus thus isolating it, essentially serving as a bronchial blocker (Figure 4, B).13 The double lumen tube was eventually introduced in 1950 by Bjork and Carlens,14 which was later redesigned by Robertshaw and has now been in practice since the 1980s (Figure 4, C).15,16 Anatomic lung resections were first performed in dogs and rabbits with en-masse ligation of the hilar structures in the 1800s.17
To highlight some of the legendary figures in the medical field who have paved the path of thoracic surgery today.
We reviewed historical articles and landmark studies published in anesthesiology, pulmonology, and thoracic surgery, and summarized them as they pertain to current practice.
Throughout our article, we have attempted to chronologically depict how our field has evolved, starting from the development of the stethoscope to reconstructing the esophagus using an extracorporeal tube to minimally invasive complex surgeries that we practice today.
We hope that our article can inspire the young minds to further grow the field and take it to higher levels.
The History of One-Lung Anesthesia and the Double-Lumen Tube
2017, Journal of Anesthesia History
Citation Excerpt :
The manufacture of both standard endotracheal tubes and the more specialized DLTs has changed gradually from rubber to plastic. The first successful plastic tube was based on the Robertshaw design and was manufactured by the National Catheter Corporation of America, which later became part of Mallinckrodt and is now owned by Covidien.33 They approached Robertshaw for advice when they were designing their tube, and he was happy to give it.
One-lung anesthesia presents many practical, anatomical, and physiological challenges to the anesthetist in modern day practice. The techniques and equipment that we use today have developed slowly over the course of the last century. The idea of isolated lung ventilation came from bronchospirometry studies by pioneering physiologists as early as 1871, and some of their original equipment was adapted for clinical use in the 1930s. Anesthetic techniques have generally been developed to facilitate surgical advances, and the development of double-lumen tubes is no exception. The development of the double-lumen tube was sporadic and occurred mainly to allow more complex thoracic procedures, mostly associated with suppurative lung disease. Once the need for independent ventilation of the lungs was identified in clinical practice, pioneers of the technique developed their own methods and often their own equipment. This led to the ability of the anesthetist to be able to control ventilation to each lung, including collapse of the operative lung and protection of the isolated lung against contamination. As these anesthetics became more reliable, the surgical scope for one-lung anesthesia began to broaden, and today one-lung ventilation is used to facilitate thoracic surgery, mainly on the lung, but also esophageal, thoracic wall, and mediastinal surgical procedures.
Comparison of postoperative sore throat and hoarseness between two types of double-lumen endobronchial tubes: A randomized controlled trial
2015, Journal of Cardiothoracic and Vascular Anesthesia
Two types of material are used to manufacture double-lumen endobronchial tubes (DLTs): Polyvinylchloride (PVC) and silicon. PVC DLTs (Broncho-Cath) and silicon DLTs (Silbroncho) not only differ in material, but also subtly differ in structure. The goal of this study was to determine whether the incidences of postoperative sore throat and hoarseness differed between PVC DLTs and silicon DLTs.
Prospective, single-blind, balanced (1:1), randomized, controlled trial.
Single university hospital.
Sixty ASA I-II patients, aged 20 to 65 years, scheduled for thoracoscopic pulmonary lobectomy.
Patients were randomized into the Broncho-cath group (group B, n = 30) and the Silbroncho group (group S, n = 30). Intubation was performed with DLT according to the allocated group by an anesthesiologist.
The incidence of sore throat and hoarseness was evaluated at 1 hour and 24 hours after DLT extubation. The intensity of sore throat was assessed by visual analog scale (VAS<0-10) at 1, 2, 4, 12, and 24 hours after DLT extubation. The incidence of sore throat was significantly lower in group S compared with that in group B at 1 h (30% v 66.7%, p = 0.018) and 24 hours (10% v 43.3%, p = 0.014). No significant difference was observed in the incidence of hoarseness between the 2 groups. The VAS scores for sore throat in group B were significantly higher than those in group S throughout the study (p< 0.05).
The use of silicon DLTs resulted in a lower incidence of postoperative sore throat than did the use of PVC DLTs.
Lung separation and the difficult airway
2009, British Journal of Anaesthesia
Citation Excerpt :
Modern plastic, disposable DLTs offer many advantages for lung separation.43 Their clear material allows observation of moisture during ventilation, the presence of secretions or blood in either lumen, or both.30 To aid in positioning, the blue bronchial cuff is easily visualized with a flexible fibreoptic bronchoscope (FOB).
Selective collapse of a lung and one-lung ventilation (OLV) is now performed for most thoracic surgical procedures. Modern double-lumen endobronchial tubes and bronchial blockers have made lung separation safe and relatively easy to achieve. However, OLV in the patient with a ‘difficult airway’ can present a challenge to the anaesthesiologist. This review considers the different techniques used to achieve lung separation and their application to the patient with a difficult airway.
Horseshoe Lung Secondary to Hypoplastic Left Lung for Pneumonectomy
2007, Journal of Cardiothoracic and Vascular Anesthesia
Citation Excerpt :
Successful blind placement of DLTs has also been described by many other workers for differential lung ventilation.11,12 A lower incidence of malposition has been reported with the newer polyvinylchloride DLTs13 as compared with Robertshaw DLTs.14 However, auscultation as a means of confirmation of DLT placement was misleading in this patient because of compensatory hyperinflation of the right lung reaching to the left side (Fig 1) resulting in reinsertion of the DLT.
Mechanical Ventilation Strategies in Massive Chest Trauma
2007, Critical Care Clinics
Patients in extremis because of trauma-related massive chest injury require expedient evaluation and prompt intervention. The initial pathophysiology relates to the significant intrapulmonary shunting caused by disruption of pulmonary capillaries and extravasation into the alveolar spaces. Disproportionate or unilateral lung involvement needs measures more technical than general supportive care. Independent lung ventilation (mostly with unilateral lung involvement) and other strategies like inhaled nitric oxide, prone positioning, partial liquid ventilation, and extracorporeal membrane oxygenation (ECMO) have had good results. Intensivists confronted with this clinical subset may consider using these strategies as alternative/adjunctive options for optimizing respiratory and hemodynamic status in the supportive management of trauma-related acute lung injury (ALI) and adult respiratory distress syndrome (ARDS).

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: Presented in part at the 47th Annual Scientific Assembly of the American College of Chest Physicians, San Francisco, CA, Oct 27, 1981.

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Advantages of a New Polyvinyl Chloride Double-Lumen Tube in Thoracic Surgery

Abstract

J Thorac Surg

J Thorac Surg

Br J Anaesth

J Thorac Cardiovasc Surg

Br J Anaesth

Ann Thorac Surg

Ann Thorac Surg

Br J Anaesth

Br J Anaesth

Br J Anaesth

Br J Anaesth

J Thorac Surg

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg