Evaluation of the Double-Lumen Tube Vivasight-DL (DLT-ETView): A Prospective Single-Center Study

Cardiopulmonary crisis caused by bronchial blocker malposition in a patient with aberrant tracheal anatomy: a case report

BACKGROUND

Double-lumen tubes (DLTs) and bronchial blockers (BBs) can be used to establish one-lung ventilation (OLV) for thoracic surgery. BBs are a good alternative when DLTs are not suitable or patients have difficult airways. However, BBs are more prone to malposition, leading to adverse events.

CASE PRESENTATION

We present a 68-year-old male patient who was scheduled for thoracoscopic left lower lobectomy. The patient was not expected to have airway malformation preoperatively. When the DLT could not be inserted into the bronchus after general anesthesia induction, we used a BB to perform OLV. During surgery, malposition of the BB resulted in the development of an "incomplete balloon valve", leading to a cardiopulmonary crisis.

CONCLUSIONS

Previewing chest computed tomography scans to assess the airway anatomy before thoracic surgery is essential. Three-dimensional reconstruction of the airway can provide a more intuitive assessment of airway anatomy. During OLV with BBs, we should pay attention to balloon malposition to prevent cardiopulmonary crises.

Video double-lumen tube for one lung ventilation: implementation and experience in 343 cases of routine clinical use during the first 20 months of the SARS-CoV-2 pandemic

BACKGROUND

Double-lumen tubes (DLTs) are the preferred device for lung isolation. Conventional DLTs (cDLT) need a bronchoscopic position control. Visualisation of correct DLT positioning could be facilitated by the use of a video double-lumen tube (vDLT). During the SARS-CoV-2-pandemic, avoiding aerosol-generation was suggesting using this device. In a large retrospective series, we report both general and pandemic related experiences with the device.

METHODS

All anesthesia records from patients aged 18 years or older undergoing surgery from April 1st, 2020 to December 31st, 2021 in the department of thoracic surgery requiring intraoperative lung isolation were analyzed retrospectively.

RESULTS

During the investigation period 343 left-sided vDLTs (77.4%) and 100 left-sided cDLTs (22.6%) were used for one lung ventilation. In the vDLT group bronchoscopy could be reduced by 85.4% related to the cDLT group. Additional bronchoscopy to reach or maintain correct position was needed in 11% of the cases. Other bronchoscopy indications occured in 3.6% of the cases. With cDLT, in 1% bronchoscopy for other indications than conforming position was observed.

CONCLUSIONS

The Ambu® VivaSight™ vDLT is an efficient, easy-to-use and safe airway device for the generation of one lung ventilation in patients undergoing thoracic surgery. The vDLT implementation was achieved easily with full interchangeability to the left-sided cDLT. Using the vDLT can reduce the need for aerosol-generating bronchoscopic interventions by 85.4%. Continuous video view to the carina enabling position monitoring of the DLT without need for bronchoscopy might be beneficial for both employee's and patient's safety.

Feasibility study of intubation in lateral position using Viva-sight double-lumen tube combined with video laryngoscope in patients undergoing pulmonary lobectomy

BACKGROUND

Double-lumen tube (DLT) intubation in lateral decubitus position is rarely reported. We designed this study to evaluate the feasibility of VivaSight double-lumen tube (VDLT) intubation assisted by video laryngoscope in lateral decubitus patients.

METHODS

Patients undergoing elective video-assisted thoracoscopic surgery (VATS) for lung lobectomy were assessed for eligibility between January 2022 and December, 2022. Eligible patients were randomly allocated into supine intubation group (group S) and lateral intubation group (group L) by a computer-generated table of random numbers. The prime objective was to observe whether the success rate of VDLT intubation in lateral position with the aid of video laryngoscope was not inferior to that in supine position.

RESULTS

A total of 116 patients were assessed, and 88 eligible patients were randomly divided into group L (n = 44) and group S (n = 44). The success rate of the first attempt intubation in the L group was 90.5%, lower than that of S group (97.7%), but there was no statistical difference (p > 0.05). Patients in both groups were intubated with VDLT for no more than 2 attempts. The mean intubation time was 91.98 ± 26.70 s in L group, and 81.39 ± 34.35 s in S group (p > 0.05). The incidence of the capsular malposition in the group L was 4.8%, less than 36.4% of group S (p < 0.001). After 24 h of follow-up, it showed a higher incidence of sore throat in group S, compared to that in group L (p = 0.009).

CONCLUSION

Our study shows the comprehensive success rate of intubation in lateral decubitus position with VDLT assisted by video laryngoscope is not inferior to that in supine position, with less risk of intraoperative tube malposition and postoperative sore throat.

TRIAL REGISTRATION

Chinese Clinical Trail Register (ChiCTR2200062989).

Effect of the VivaSight double-lumen tube on the incidence of hypoxaemia during one-lung ventilation in patients undergoing thoracoscopic surgery: a study protocol for a prospective randomised controlled trial

INTRODUCTION

A double-lumen tube (DLT) is a traditional one-lung ventilation tool that needs to be positioned under the guidance of a fibreoptic bronchoscope or auscultation. The placement is complex, and poor positioning often causes hypoxaemia. In recent years, VivaSight double-lumen tubes (v-DLTs) have been widely used in thoracic surgery. Because the tubes can be continuously observed during intubation and the operation, malposition can be corrected at any time. However, the effect of v-DLT on perioperative hypoxaemia has been rarely reported. The aim of this study was to observe the incidence of hypoxaemia during one-lung ventilation with v-DLT and to compare the perioperative complications between v-DLT and conventional double-lumen tube (c-DLT).

METHODS AND ANALYSIS

One hundred patients planning to undergo thoracoscopic surgery will be randomised into the c-DLT group and the v-DLT group. During one-lung ventilation, both groups of patients will receive low tidal volume for volume control ventilation. When the blood oxygen saturation falls below 95%, the DLT will be repositioned and the oxygen concentration will be increased to improve the respiratory parameters (5 cm H₂O Positive end-expiratory pressure (PEEP) on the ventilation side and 5 cm H₂O CPAP (continuous airway positive pressure) on the operation side), and double lung ventilation measures will be taken in sequence to prevent a further decline in blood oxygen saturation. The primary outcomes are the incidence and duration of hypoxaemia and the number of intraoperative hypoxaemia treatments, and the secondary outcomes will be postoperative complications and total hospitalisation expenses.

ETHICS AND DISSEMINATION

The study protocol was approved by the Clinical Research Ethics Committee of The First Affiliated Hospital, Sun Yat-sen University (2020-418) and registered at the Chinese Clinical Trial Registry (http://www.chictr.org.cn). The results of the study will be analysed and reported.

TRIAL REGISTRATION NUMBER

ChiCTR2100046484.

[Video-assisted Double-lumen Tubes in Robot-assisted Oesophageal Surgery]

Robot-assisted esophagectomies are still considered high-risk procedures requiring complex surgical and anesthesiological planning and coordination. The operative space during the thoracic operative part is created by one-lung ventilation. Due to special patient positioning and intraoperative repositioning maneuvers, however, access to patient airway or double-lumen tube manipulation, if necessary, is only possible to a certain extent. In this work, we present our experiences establishing a video-guided double-lumen tube for esophageal surgery. From our point of view, the use of video-guided double-lumen tubes is very suitable increasing patient safety and coordination in the operational team during esophagectomy.

[Application and Research Progress of Video Double-lumen Tube in Thoracic Surgery]

The rapid development and promotion of minimally invasive thoracic surgery represented by video-assisted thoracoscopy surgery has gradually replaced traditional thoracic surgery technique as the primary choice for the treatment of pulmonary nodules, including early lung cancer. With the clinical application of double-lumen bronchial catheters, the realization of one-lung ventilation technology not only provides a solid anesthesia foundation for the popularization of minimally invasive thoracic surgery, but also provides a guarantee for the rapid and smooth implementation of the operation. However, compared with single-lumen bronchial catheters, the diameter of the double-lumen bronchial catheter is thicker, and the tube body is hard and difficult to shape, which brings inconvenience to anesthesia intubation. The bronchial structure is different, and the incidence of dislocation during anesthesia intubation is also high. With the gradual clinical use of video double-lumen tube (VDLT), it has become a hot spot in thoracic surgery in recent years. This article reviews the application and research progress of VDLT in thoracic surgery.
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Intubation with vivasight double-lumen tube versus conventional double-lumen tube in adult patients undergoing lung resection: A retrospective analysis

Objectives

The present study was designed to compare outcomes in patients undergoing thoracic surgery using the VivaSight double-lumen tube (VDLT) or the conventional double-lumen tube (cDLT).

Design

A retrospective analysis of 100 patients scheduled for lung resection recruited over 21 consecutive months (January 2018-September 2019).

Setting

Single-center university teaching hospital investigation.

Participants

A randomized sample of 100 patients who underwent lung resection during this period were selected for the purpose to compare 50 patients in the VDLT group and 50 in the cDLT group.

Interventions

After institutional review board approval, patients were chosen according to inclusion and exclusion criteria and we created a general database. The 100 patients have been chosen through a random process with the Microsoft Excel program (Microsoft 2018, Version 16.16.16).

Measurements and Main Results

The primary endpoint of the study was to analyze the need to use fiberoptic bronchoscopy to confirm the correct positioning of VDLT or the cDLT used for lung isolation. Secondary endpoints were respiratory parameters, admission to the intensive care unit, length of hospitalization, postoperative complications, readmission, and 30-day mortality rate. The use of fiberoptic bronchoscopy was lower in the VDLT group, and the size of the tube was smaller. The intraoperative respiratory and hemodynamics parameters were optimal. There were no other preoperative, intraoperative, or postoperative differences between both groups.

Conclusions

The VDLT reduces the need for fiberoptic bronchoscopy, and it seems that a smaller size is needed. Finally, VDLT is cost-effective using disposable fiberscopes.

Optical Devices in Tracheal Intubation-State of the Art in 2020

The review article is focused on developments in optical devices, other than laryngoscopes, in airway management and tracheal intubation. It brings information on advantages and limitations in their use, compares different devices, and summarizes benefits in various clinical settings. Supraglottic airway devices may be used as a conduit for fiberscope-guided tracheal intubation mainly as a rescue plan in the scenario of difficult or failed laryngoscopy. Some of these devices offer the possibility of direct endotracheal tube placement. Hybrid devices combine the features of two different intubating tools. Rigid and semi-rigid optical stylets represent another option in airway management. They offer benefits in restricted mouth opening and may be used also for retromolar intubation. Awake flexible fiberoptic intubation has been a gold standard in predicted difficult laryngoscopy for decades. Modern flexible bronchoscopes used in anesthesia and intensive care are disposable devices and contain optical lenses instead of fibers. Endotracheal tubes with an incorporated optics are used mainly in thoracic anesthesia for lung separation. They are available in double-lumen and single-lumen versions. They offer a benefit of direct view to the carina and do not require flexible fiberscope for their correct placement.

Comparing the rate of fiberoptic bronchoscopy use with a video double lumen tube versus a conventional double lumen tube-a randomized controlled trial

Background

Double lumen endotracheal tubes (DLT) are commonly used to provide single lung ventilation during thoracic surgery. A fiberoptic bronchoscope (FOB) is typically used to confirm accurate DLT placement. Accounting for initial purchase, maintenance, repair and cleaning, the use of an FOB can cost as much as $312 per procedure. The VivaSight DLT (VS-DLT) incorporates a built-in camera, which is aimed at reducing FOB use and its associated costs. In this study, we compared the rate of FOB use when intubating using either a VS-DLT or a conventional DLT (c-DLT).

Methods

This is a randomized controlled comparative study performed at a public county teaching hospital. A total of 50 patients were enrolled and randomly assigned to either a c-DLT (n=25) or a VS-DLT (n=25). The primary outcome was the rate of FOB use. Secondary outcomes included time to correct tube placement and incidence of malposition during surgery.

Results

Use of the VS-DLT required significantly less FOB use (28%) compared to use of the c-DLT (100%). While there was no difference in the ease of intubation, the time to correct tube placement was significantly faster using a VS-DLT (54 vs. 156 s, P<0.001). Additionally, the incidence of tube malposition was significantly reduced in the VS-DLT group.

Conclusions

This study demonstrated a significantly lower rate of FOB use when using a VS-DLT compared to a c-DLT. Placement of the VS-DLT was significantly quicker and malposition during surgery occurred significantly less than with the c-DLT. While intubating with a VS-DLT provides clinical benefits, it may not result in significant cost reductions when compared to a c-DLT.

Recommendations from the Italian intersociety consensus on Perioperative Anesthesa Care in Thoracic surgery (PACTS) part 2: intraoperative and postoperative care

Introduction

Anesthetic care in patients undergoing thoracic surgery presents specific challenges that require a multidisciplinary approach to management. There remains a need for standardized, evidence-based, continuously updated guidelines for perioperative care in these patients.

Methods

A multidisciplinary expert group, the Perioperative Anesthesia in Thoracic Surgery (PACTS) group, was established to develop recommendations for anesthesia practice in patients undergoing elective lung resection for lung cancer. The project addressed three key areas: preoperative patient assessment and preparation, intraoperative management (surgical and anesthesiologic care), and postoperative care and discharge. A series of clinical questions was developed, and literature searches were performed to inform discussions around these areas, leading to the development of 69 recommendations. The quality of evidence and strength of recommendations were graded using the United States Preventive Services Task Force criteria.

Results

Recommendations for intraoperative care focus on airway management, and monitoring of vital signs, hemodynamics, blood gases, neuromuscular blockade, and depth of anesthesia. Recommendations for postoperative care focus on the provision of multimodal analgesia, intensive care unit (ICU) care, and specific measures such as chest drainage, mobilization, noninvasive ventilation, and atrial fibrillation prophylaxis.

Conclusions

These recommendations should help clinicians to improve intraoperative and postoperative management, and thereby achieve better postoperative outcomes in thoracic surgery patients. Further refinement of the recommendations can be anticipated as the literature continues to evolve.

Evaluation of time to intubation and rate of success for different healthcare professionals using a double-lumen left-sided endotracheal video tube: A prospective observational study

Intubation with a double-lumen left-sided endotracheal video tube has been the standard procedure for nearly five years in the Department of Cardiothoracic Surgery, Copenhagen University Hospital, but no systematic evaluations have been done. For a 12-month period ending November 2017, data were collected from 579 consecutive patients, scheduled for thoracic surgery with a requirement for one-lung ventilation; 35 anaesthetist trainees (nurses or doctors) (287 cases), 27 nurse anaesthetists (239 cases) and 8 anaesthesiologists (53 cases) managed intubation with a double-lumen tube. Time to intubation was relatively equal across healthcare professionals with a mean time of 53 (anaesthetist trainees), 40 (nurse anaesthetists) and 63 (anaesthesiologists) seconds. The shorter time for nurse anaesthetists and prolonged time for anaesthesiologists might be due to the small number of cases and the fact that anaesthesiologists carried out 60% of the cases, where a third attempt was needed, and 25% of cases for the anaesthesiologists were assessed to a Cormack-Lehane grade of 3 or 4 compared to 6% for anaesthetist trainees and 5% for nurse anaesthetists. The rate of successful placement in the first attempt of placing the double-lumen left-sided endotracheal video tube was high, which emphasises that intubation with a double-lumen left-sided endotracheal video tube is suitable for use by different healthcare professionals.

Lung Isolation in the Patient With a Difficult Airway

One-lung ventilation is routinely used to facilitate exposure for thoracic surgical procedures and can be achieved via several lung isolation techniques. The optimal method for lung isolation depends on a number of factors that include (1) the indication for lung isolation, (2) anatomic features of the upper and lower airway, (3) availability of equipment and devices, and (4) the anesthesiologist's proficiency and preferences. Though double-lumen endobronchial tubes (DLTs) are most commonly utilized to achieve lung isolation, the use of endobronchial blockers offer advantages in patients with challenging airway anatomy. Anesthesiologists should be familiar with existing alternatives to the DLT for lung isolation and alternative techniques for DLT placement in the patient with a difficult airway. Newer technologies such as videolaryngoscopy with or without adjunctive fiberoptic bronchoscopy may facilitate intubation and lung isolation in difficult airway management.

A randomised trial comparing real-time double-lumen endobronchial tube placement with the Disposcope® with conventional blind placement

Double-lumen endobronchial tube placement is challenging. This study compared double-lumen tube placement with the Disposcope^® , a wireless videostylet allowing real-time visualisation, with conventional blind placement. Patients undergoing elective thoracic surgery with normal airways requiring one-lung ventilation were randomly allocated into two groups (27 patients in each group). The Disposcope was used to assist left-sided double-lumen tube placement in one group, and conventional blind placement was performed in the control group. Placement in both groups was checked with fibreoptic bronchoscopy. The Disposcope-assisted group had a shorter total mean (SD) placement time (18.6 (2.5) s vs. 21.4 (2.9) s, p < 0.001), laryngoscopy to end of auscultation time (83.4 (3.0) s vs. 93.9 (5.7) s, p < 0.001) and total operation time (130.7 (6.1) s vs. 154.5 (6.3) s, p < 0.001). In the Disposcope-assisted group, the double-lumen tube was inserted in the correct side in all patients (100.0%), whereas in the conventional group, the double-lumen tube was placed in the correct side in 25 (92.6%) patients and in the wrong side in 2 (7.4%) patients; the difference was not significant (p = 0.150). In the Disposcope-assisted group, the double-lumen tube was inserted to the optimal depth in 24 (88.9%) patients, whereas in the conventional group it was inserted to the optimal depth in one (4.0%) patient. The Disposcope increased the success rate of double-lumen tube placement, and shortened the total operation time when compared with standard placement with confirmation using fibreoptic bronchoscopy, and may replace the conventional method.

The use of ETView endotracheal tube for surveillance after tube positioning in patients undergoing lobectomy, randomized trial

The ETView tracheoscopic ventilation tube (TVT) is a tracheal tube (TT) incorporating a video camera and a light source in its tip. The view from the tip appears continuously on a portable monitor in the anesthesia area. We evaluated the effectiveness and usefulness of the single/double ETView TVT in monitoring the tracheal tube position during general anesthesia undergoing video-assisted thoracoscopic lobectomy.Eighty-three patients with pulmonary bullae (American Society of Anesthesiologists (ASA) I-III) undergoing lobectomy, with general anaesthesia, were included. Patients were randomly assigned to 3 groups, based on the tube ETView double-lumen tube (VDT), ETView single-lumen tube (VST), or traditional double lumen tube (DT).All 83 patients' intubations were successful to achieve 1-lung ventilation: 74 patients at the first attempt (22/26 in VDT, 26/28 in VST, 26/29 in DT group) and 9 patients at the second attempt. The time to achieve 1-lung ventilation with the VDT was 58.5 ± 21.5 (mean ± SD) seconds, the VST was 38.2 ± 10.1 (mean ± SD) seconds, and the DT group was 195.5 ± 40.3 (mean ± SD) seconds. During operations, the ETView tubes provided continuous airway visualization in all patients; a good view was obtained in 24/25 patients in VDT/VST, moderate in 4/12 patients in VDT/VST, and poor in 1/1 patients in VDT/VST. When the patient left the postanesthesia care unit, all had sore throat and 26/15/25 patients in VDT/VST/DT group had hoarseness. All had good outcomes of the surgical operations.We found the ETView tube to be helpful in the endotracheal intubation and continuous surveillance of tube position in patients with video-assisted thoracoscopic lobectomy. The ETView single lumen endotracheal tube had fewer associated complications and is superior to the 2 double-lumen tubes.

A six-month evaluation of the VivaSight™ video double-lumen endotracheal tube after introduction into thoracic anaesthetic practice at a single institution

For a six-month period, all airway options used for non-emergent patients undergoing thoracic surgery requiring one-lung ventilation at a single institution were assessed after introduction of the VivaSight™ double-lumen endotracheal tube (VivaSight-DL), a novel double-lumen tube with an integrated camera. This device displays a continuous view of the position of the tube relative to the carina. A total of 72 patients had lung separation with the VivaSight-DL. Lung separation was achieved on first attempt without additional manipulation in 85% of cases. In only three cases (4%) was a fibreoptic bronchoscope required, in each instance to reposition the tube after intraoperative dislodgement. The VivaSight-DL represents a novel method of one-lung ventilation allowing rapid identification of intraoperative airway problems and reducing the need for fibreoptic bronchoscopy.

A Randomized Controlled Study of the Use of Video Double-Lumen Endobronchial Tubes Versus Double-Lumen Endobronchial Tubes in Thoracic Surgery

OBJECTIVE

To compare the incidence of fiberoptic bronchoscope (FOB) use (1) during verification of initial placement and (2) for reconfirmation of correct placement following repositioning, when either a double-lumen tube (DLT) or video double-lumen tube (VDLT) was used for lung isolation during thoracic surgery.

DESIGN

A randomized controlled study.

SETTING

Single-center university teaching hospital.

PARTICIPANTS

The study comprised 80 patients who were 18 years or older requiring lung isolation for surgery.

INTERVENTIONS

After institutional review board approval, patients were randomized prior to surgery to either DLT or VDLT usage. Attending anesthesiologists placed the Mallinckrodt DLT or Vivasight (ET View Ltd, Misgav, Israel) VDLT with conventional laryngoscopy or video laryngoscopy then verified correct tube position through the view provided with either VDLT external monitor or FOB.

MEASUREMENTS AND MAIN RESULTS

Data collected included: sex, body mass index, successful intubation and endobronchial placement, intubation time, confirmation time of tube position, FOB use, quality of view, dislodgement of tube, and ability to forewarn dislodgement of endobronchial cuff and complications. FOB use for verification of final position of the tube (VDLT 13.2% [5/38] v DLT 100% [42/42], p < 0.0001), need for FOB to correct the dislodgement (VDLT 7.7% [1/13] v DLT 100% [14/14], p < 0.0001), dislodgement during positioning (VDLT 61.5% [8/13] v DLT 64.3% [9/14], p = ns), dislodgement during surgery (VDLT 38.5% [5/13] v DLT 21.4% [3/14], p = ns), and ability to forewarn dislodgement of endobronchial cuff (VDLT 18.4% [7/38] v DLT 4.8% [2/42], p = 0.078).

CONCLUSION

This study demonstrated a reduction of 86.8% in FOB use, which was a similar reduction found in other published studies.

McGrath Series 5 videolaryngoscope vs Airtraq DL videolaryngoscope for double-lumen tube intubation: A randomized trial

BACKGROUND

Many studies have shown Airtraq videolaryngoscope provided faster tracheal intubation and a higher success rate than other videolaryngoscopes. Recently, different types of videolaryngoscopes have been reported for use in double-lumen tube (DLT) intubation. However, the advantages and disadvantages between them remain undetermined for DLT intubation. In this study, we compared the Airtraq DL videolaryngoscope with the McGrath Series 5 videolaryngoscope for DLT intubation by experienced anesthesiologists.

METHODS

Ninety patients with expected normal airways were randomly allocated to either the Airtraq or McGrath group. The primary outcome was DLT intubation time. The secondary outcomes were glottic view, success rate, subjective ease of intubation (100-mm visual analog scale, 0 = easy; 100 = difficult), incidence of DLT malposition, and postoperative intubation-related complication.

RESULTS

The airway characteristics were comparable between the 2 groups. Cormack and Lehane grades significantly improved with the use of the McGrath and Airtraq videolaryngoscopes, compared with the Macintosh laryngoscope. The intubation success rate on the first attempt was 93% in the Airtraq group and 95% in the McGrath group (P > 0.05). The intubation time in the McGrath group is longer than that in the Airtraq group (39.9 [9.1]s vs 28.6 [13.6]s, P < 0.05). But intubation difficulty score, the incidence of DLT malposition and intubation-related complication were comparable between groups (P > 0.05).

CONCLUSIONS

When using videolaryngoscopes for DLT intubation, the Airtraq DL is superior to the McGrath Series 5 in intubation time, but it does not decrease intubation difficulty.

VivaSight: a new era in the evolution of tracheal tubes

STUDY OBJECTIVE

To evaluate the available data describing the use of single and double lumen VivaSight tubes.

DESIGN

Systematic review.

SETTING

The use of VivaSight tubes for elective surgeries including advantages, disadvantages, and possible complications.

PATIENTS

Systematic review of randomized controlled trials from databases including Medline, Web of Knowledge, Google Scholar, and Cochrane Central Register of Controlled Trials.

INTERVENTIONS

Comparison of VivaSight single and double-lumen tubes with conventional tubes during normal airway and expected difficult airway management. The effectiveness of the devices was also evaluated during 1-lung ventilation for patients undergoing thoracic surgery.

MEASUREMENTS

Intubation time, success rate, the requirement for fiberoptic bronchoscope, and the rate of complications.

MAIN RESULTS

Following a VivaSight double-lumen tube, a flexible bronchoscope is still needed. It is difficult to agree that VivaSight tube reduces the need or use of a bronchoscope. According to the current literature, it is unclear if there is any advantage of the VivaSight compared with using flexible bronchoscopy to direct a blocker into the correct lung. The cost may be another issue. Studies comparing VivaSight tubes with standard double lumen tubes reported faster tracheal intubation rate and higher success rate at first attempt for VivaSight. However, VivaSight tubes may cause soft tissue trauma such as bleeding, hematoma, edema, and erythema. Sore throat and dysphonia are other reported complications. Due to the outer thickness, smaller-sized double-lumen tube may be necessary. It has been reported to have the disadvantages, such as melting due to the heat of light source before insertion and sudden shutdown without warning.

CONCLUSIONS

Problems such as overheating and melting on the distal end of the tube due to the light source and potential breakdowns of the cable should be solved by the manufacturer. This will probably require a redesign and necessitate further studies.