Harvard Medical School, Department of Anesthesiology, Pain Medicine, and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA.
The Ohio State University College of Medicine, Columbus, OH, USA.
Semin Cardiothorac Vasc Anesth. 2023 Sep;27(3):171-180. doi: 10.1177/10892532231184781. Epub 2023 Jun 22.
The EZ-Blocker is the newest generation of bronchial blocker and offers a potential alternative to left-sided double lumen tubes for lung isolation and one-lung ventilation during thoracic surgery. Databases were searched for randomized controlled trials comparing left-sided double lumen tube to the EZ-Blocker for one-lung ventilation during thoracic surgery. The time for placement, incidence of intraoperative displacement, and surgeons' rating of lung collapse quality were designated as coprimary outcomes. The safety profiles of the two devices, including the incidence of airway trauma and post-extubation discomfort were also examined. Six randomized controlled trials (495 patients) were analyzed. Compared to the EZ-Blocker, the left-sided double lumen tube was faster to place by a weighted mean difference of [95% CI] of -61.24 seconds [-102.48, -20.00] (P = .004) and was much less likely to become displaced during lung isolation with an odds ratio [95% CI] of .56 [.34, .91] (P = .02). The left-sided double lumen tube and the EZ-Blocker provided similar surgeon-rated quality of lung isolation. Although the left-sided double lumen tube caused a greater degree of post-extubation sore throat, there was a similar incidence of carinal trauma and post-extubation hoarseness compared to the EZ-Blocker. Our analysis suggests that the left-sided double lumen tube can be placed more quickly and is less prone to intraoperative displacement compared to the EZ-Blocker; the quality of lung collapse is similar. Thus, evidence appears to support the continued utilization of the left-sided double lumen tube for routine thoracic surgery requiring one-lung ventilation.
EZ-Blocker 是新一代支气管阻塞器，可为胸科手术中的肺隔离和单肺通气提供一种替代左侧双腔管的潜在选择。 我们在数据库中搜索了比较左侧双腔管和 EZ-Blocker 在胸科手术中单肺通气的随机对照试验。放置时间、术中移位发生率和外科医生对肺塌陷质量的评分被指定为主要结局。还检查了两种设备的安全性概况，包括气道创伤和拔管后不适的发生率。 共分析了 6 项随机对照试验（495 例患者）。与 EZ-Blocker 相比，左侧双腔管的放置速度更快，加权均数差值为 [95%CI] -61.24 秒[-102.48, -20.00]（P =.004），且在肺隔离期间发生移位的可能性要小得多，优势比 [95%CI]为.56 [.34,.91]（P =.02）。左侧双腔管和 EZ-Blocker 提供了类似的外科医生评价的肺隔离质量。尽管左侧双腔管导致拔管后喉咙痛的程度更大，但与 EZ-Blocker 相比，发生隆突创伤和拔管后声音嘶哑的发生率相似。 我们的分析表明，与 EZ-Blocker 相比，左侧双腔管可以更快地放置，且术中移位的可能性更小；肺塌陷的质量相似。因此，有证据支持继续在需要单肺通气的常规胸科手术中使用左侧双腔管。
