Objective: To compare the efficacy and adverse effects of
using bronchial blockers (BBs) and double-lumen endobronchial
tubes (DLTs).
Design: Systematic review and meta-analysis of randomized
controlled trials (RCTs) comparing BBs and DLTs.
Setting: Hospital units undertaking thoracic surgery
Participants: Patients undergoing thoracic surgery requiring
lung isolation.
Interventions: BBs and DLTs.
Measurements and Main Results: A systematic literature
search was conducted for RCTs comparing BBs and DLTs
using Google Scholar, Ovid Medline, and Cochrane library
databases up to October 2013. Inclusion criteria were RCTs
comparing BBs and DLTs, intubation carried out by qualified
anesthesiologists or trainee specialists, outcome measures
relating to either efficacy or adverse effects. Studies that
were inaccessible in English were excluded. MantelHaenszel
fixed-effect meta-analysis of recurring outcome
measures was performed using RevMan 5 software. The
search produced 39 RCTs published between 1996 and 2013.
DLTs were quicker to place (mean difference: 51 seconds,
95% confidence intervals [CI] 8-94 seconds; p ¼ 0.02) and
less likely to be incorrectly positioned (odds ratio [OR] 2.70;
95% CI 1.18-6.18, p ¼ 0.02) than BBs. BBs were associated
with fewer patients having a postoperative sore throat (OR
0.39, 95% CI: 0.23-0.68, p ¼ 0.0009), less hoarseness (OR:
0.43,95%, CI 0.24-0.75, p ¼ 0.003), and fewer airway injuries
(OR 0.40, 95% CI 0.21-0.75, p ¼ 0.005) than DLTs.
Conclusion: While BBs are associated with a lower incidence
of airway injury and a lower severity of injury, DLTs
can be placed quicker and more reliably.
& 2015 Elsevier Inc. All rights reserved.
KEY WORDS: bronchial blocker, double-lumen endobronchial
tube, lung isolation, one-lung ventilation, thoracic surgery,
efficacy, adverse effects