A Randomized Controlled Trial Comparing Novel Triple-Cuffed Double-Lumen Endobronchial Tubes with Conventional Double-Lumen Endobronchial Tubes for Lung Isolation

Namo Kim, Hyo-Jin Byon, Go Eun Kim, Chungon Park, Young Eun Joe, Sung Min Suh, Young Jun Oh, Namo Kim, Hyo-Jin Byon, Go Eun Kim, Chungon Park, Young Eun Joe, Sung Min Suh, Young Jun Oh

Abstract

Placing a double-lumen endobronchial tube (DLT) in an appropriate position to facilitate lung isolation is essential for thoracic procedures. The novel ANKOR DLT is a DLT developed with three cuffs with a newly added carinal cuff designed to prevent further advancement by being blocked by the carina when the cuff is inflated. In this prospective study, the direction and depth of initial placement of ANKOR DLT were compared with those of conventional DLT. Patients undergoing thoracic surgery (n = 190) with one-lung ventilation (OLV) were randomly allocated into either left-sided conventional DLT group (n = 95) or left-sided ANKOR DLT group (n = 95). The direction and depth of DLT position were compared via fiberoptic bronchoscopy (FOB) after endobronchial intubation between the groups. There was no significant difference in the number of right mainstem endobronchial intubations between the two groups (p = 0.468). The difference between the initial depth of DLT placement and the target depth confirmed by FOB was significantly lower in the ANKOR DLT group than in the conventional DLT group (1.8 ± 1.8 vs. 12.9 ± 9.7 mm; p < 0.001). In conclusion, the ANKOR DLT facilitated its initial positioning at the optimal depth compared to the conventional DLT.

Keywords: airway; double-lumen endobronchial tubes; fiberoptic bronchoscope; one-lung ventilation; thoracic surgery.

Conflict of interest statement

Young Jun Oh and Hyo-Jin Byon hold the intellectual property rights to the design of the ANKORTM double-lumen endobronchial tube, and they have licensed it to Insung Medical. Co. None of the other authors have any conflicts of interest.

Figures

Figure 1
Figure 1
CONSORT flow diagram. DLT, double-lumen endobronchial tube; FOB, fiberoptic bronchoscopy.
Figure 2
Figure 2
Schematic illustration showing the use of ANKOR double-lumen endobronchial tube (DLT). (A) The carinal cuff (green color, indicated by the white arrows) of the tube passed beyond the vocal cord, and the ANKOR DLT was turned to the left; (B) The carinal cuff was inflated with 5 to 7 mL of air; (C) The ANKOR DLT was advanced until the inflated carinal cuff is functionally anchored at the keel-shaped carinal ridge; and (D) After the deflation of the carinal cuff, the tracheal cuff (white color) and the bronchial cuff (blue color) of the tube were inflated with air.

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