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Javier H Campos - One of the best experts on this subject based on the ideXlab platform.

  • Lung Separation in the Morbidly Obese Patient
    2020
    Co-Authors: Javier H Campos, Kenichi Ueda
    Abstract:

    Lung separation techniques in the morbidly obese patient undergoing thoracic or esophageal surgery may be at risk of complications during airway management. Access to the airway in the obese patient can be a challenge because they have altered airway anatomy, including a short and redundant neck, limited neck extension and accumulation of fat deposition in the pharyngeal wall contributing to difficult laryngoscopy. Securing the airway is the first priority in these patients followed by appropriate techniques for lung separation with the use of a single-lumen Endotracheal Tube and a bronchial blocker or another alternative is with the use of a Double-Lumen Endotracheal Tube. This review is focused on the use of lung isolation devices in the obese patient. The recommendations are based upon scientific evidence, case reports or personal experience. Fiberoptic bronchoscopy must be used to place and confirm proper placement of a single-lumen Endotracheal Tube, bronchial blocker or Double-Lumen Endotracheal Tube

  • lung isolation techniques in patients with early stage or long term tracheostomy a case series report of 70 cases and recommendations
    Journal of Cardiothoracic and Vascular Anesthesia, 2019
    Co-Authors: Javier H Campos, Eli D Musselman, Satoshi Hanada, Kenichi Ueda
    Abstract:

    Objectives Lung isolation techniques are designed to facilitate surgical exposure in thoracic surgical patients and provide one-lung ventilation (OLV). Some patients have a tracheostomy in situ, which makes the management of the airway and OLV difficult. The objective of this retrospective study was to review cases that had a tracheostomy prior to thoracic surgery and evaluate the clinical use and efficiency with the airway management and lung isolation devices. Design This was a retrospective data analysis. Setting Tertiary care university hospital. Interventions After institutional review board approval, the authors reviewed 3,225 charts of patients who had thoracic surgery involving OLV. Seventy patients were identified who had tracheostomy in situ. Each case was reviewed regarding airway management and lung isolation technique. Measurements and Main Results The authors identified 70 patients who had a tracheostomy in situ. The cases were divided into 2 groups: a fresh tracheostomy stoma 7 days (n = 64). The authors collected information regarding the devices used to manage the airway and lung isolation techniques. The devices used to manage the airway include the Shiley cuffed low pressure tracheostomy Tube, single-lumen Endotracheal Tube (SLT), or Double-Lumen Endotracheal Tube (DLT). Devices used to manage OLV included SLTs, with or without bronchial blockers, or DLTs. Flexible fiberoptic bronchoscopy was used to assess the airway and confirm the position of the lung isolation device. Six cases had an early-stage fresh tracheostomy stoma where the Shiley tracheostomy Tube was used for ventilation followed by the use of a bronchial blocker. In contrast, for the patients who had a long-term stoma, the following devices were used: (1) a SLT plus a bronchial blocker in 38 cases, a Shiley tracheostomy Tube plus bronchial blocker in 15 cases, use of a SLT guided into a selective bronchus in 7 cases, and use of a DLT in 4 cases. In all cases, flexible fiberoptic bronchoscopy was used and no complications occurred secondary to airway management or OLV. Conclusion In patients undergoing thoracic surgery and OLV, and with a fresh tracheostomy stoma in situ, the authors recommend the use of the Shiley tracheostomy Tube plus a bronchial blocker. In patients with a long-term tracheostomy stoma, a SLT can be used selectively to intubate 1 bronchus. In addition, an SLT or a Shiley Tube can be used in conjunction with an independent bronchial blocker, such as the Arndt wire-guided bronchial blocker, Cohen tip-deflecting blocker, Fuji Uniblocker, or EZ-Blocker. DLTs are the least frequently used device for OLV in tracheostomized patients.

  • REVIEW ARTICLE An Update on Bronchial Blockers During Lung Separation Techniques in Adults
    2015
    Co-Authors: Javier H Campos
    Abstract:

    T echniques for one-lung ventilation (OLV) can beaccomplished in two different ways. The firstinvolves the use of a Double-Lumen Endotracheal Tube (DLT). The second method involves blockade of a mainstem bronchus to allow lung collapse distal to the occlusion (bronchial blockers) (1–3). In 1936, Magill (4) achieved bronchial blockade using a long Tube with an inflatable cuff at its distal end that was advanced alongside a single-lumen Endotracheal Tube. Since then, more devices have been introduced including: 1) the Fogarty vascular embolectomy catheter (5) [Ed

  • doi:10.1155/2012/207598 Review Article Lung Separation in the Morbidly Obese Patient
    2013
    Co-Authors: Javier H Campos, Kenichi Ueda
    Abstract:

    License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Lung separation techniques in the morbidly obese patient undergoing thoracic or esophageal surgery may be at risk of complications during airway management. Access to the airway in the obese patient can be a challenge because they have altered airway anatomy, including a short and redundant neck, limited neck extension and accumulation of fat deposition in the pharyngeal wall contributing to difficult laryngoscopy. Securing the airway is the first priority in these patients followed by appropriate techniques for lung separation with the use of a single-lumen Endotracheal Tube and a bronchial blocker or another alternative is with the use of a Double-Lumen Endotracheal Tube. This review is focused on the use of lung isolation devices in the obese patient. The recommendations are based upon scientific evidence, case reports or personal experience. Fiberoptic bronchoscopy must be used to place and confirm proper placement of a single-lumen Endotracheal Tube, bronchial blocker or Double-Lumen Endotracheal Tube. 1

  • anesthesia for robotic thoracic surgery
    2011
    Co-Authors: Javier H Campos
    Abstract:

    The management of the robotic thoracic surgical patient requires the knowledge of minimally invasive surgery techniques involving the chest. Familiarity with the da Vinci® robot surgical system by the anesthesiologist is mandatory. Management of one-lung ventilation techniques with a left-sided Double-Lumen Endotracheal Tube or an independent bronchial blocker is required, along with flexible fiberoptic bronchoscopy techniques. Patient positioning and prevention of complications such as nerve or crashing injuries while the robotic system is used. Recognition of the hemodynamic effects of carbon dioxide (CO2) during insufflation in the chest is required. Potential for conversion to open thoracotomy or open procedure in the abdomen.

Sunghye Byun - One of the best experts on this subject based on the ideXlab platform.

  • changes in the bronchial cuff pressure of left sided double lumen Endotracheal Tube by lateral positioning a prospective observational study
    Journal of Clinical Medicine, 2021
    Co-Authors: Jong Hae Kim, Eugene S Kim, Inyoung Kim, Eunjoo Choi, Sunghye Byun
    Abstract:

    Proper bronchial cuff pressure (BCP) is important when using a Double-Lumen Endotracheal Tube (DLT), especially in thoracic surgery. As positional change during Endotracheal Tube placement could alter cuff pressure, we aim to evaluate the change in BCP of DLT from the supine to the lateral decubitus position during thoracic surgery. A total of 69 patients aged 18–70 years who underwent elective lung surgery were recruited. BCP was measured at a series of time points in the supine and lateral decubitus positions after confirming the DLT placement. The primary outcome was change in the initial established BCP (BCPi), which is the maximum pressure at which the BCP did not exceed 40 cmH2O without air leak in the supine position, after lateral decubitus positioning. As the primary outcome, the BCPi increased from 25.4 ± 9.0 cmH2O in the supine position to 29.1 ± 12.2 cmH2O in the lateral decubitus position (p < 0.001). Out of the 69 participants, 43 and 26 patients underwent surgery in the left-lateral decubitus position (LLD group) and the right-lateral decubitus position (RLD group) respectively. In the LLD group, the BCPi increased significantly (p < 0.001) after lateral positioning and the beginning of surgery and the difference value, ∆BCPi, from supine to lateral position was significantly higher in the LLD group than in the RLD group (p = 0.034). Positional change from supine to lateral decubitus could increase the BCPi of DLT and the increase was significantly greater in LLD that in RLD.

  • effect of lateral positioning on the bronchial cuff pressure of a left sided double lumen Endotracheal Tube during thoracic surgery study protocol for a prospective observational study
    BMJ Open, 2019
    Co-Authors: Eugene S Kim, Inyoung Kim, Sunghye Byun
    Abstract:

    Introduction Correct pressure is important when using a Double-Lumen Endotracheal Tube (DLT), especially in thoracic surgery. An inadequate bronchial cuff pressure (BCP) can cause air leak and interfere with visualisation of the surgical field, whereas an excessive pressure BCP can lead to cuff-related complications. Based on several reports that cuff pressure could alter after a positional change when using an Endotracheal Tube, we hypothesise that a change from the supine position to the lateral decubitus position, which is essential for thoracic surgery, would affect the BCP of the DLT. Methods and analysis This prospective, single-centre, observational study will enrol 74 patients aged 18–70 years undergoing elective lung surgery from September 2018 to April 2019. The primary outcome will be the change in the ‘initially established BCP’ (maximum BCP not exceeding 40 cm H2O with no air leak in the supine position) after lateral decubitus positioning. BCP and air leak will be assessed in each patient position during inflation of the cuff with air in 0.5 mL increments from 0 to 3 mL. Secondary outcomes will include the incidence of BCP exceeding 40 cm H2O after the initial established value and that of a change in the smallest bronchial cuff volume without air leak after a change to the lateral position. The relationship between the change in BCP and airway pressure, compliance and body mass index after lateral positioning will be investigated. Ethics and dissemination The study will be conducted in accordance with the Declaration of Helsinki and supervised by the Daegu Catholic University Medical Center institutional review board (study approval number CR-18–111). All patients will receive information about the study and will need to provide written informed consent before enrolment. The results will be presented at an international meeting and published in a peer-reviewed journal. Trial registration number NCT03656406; Pre-results.

  • comparing the placement of a left sided double lumen Tube via fiberoptic bronchoscopy guidance versus conventional intubation using a macintosh laryngoscope to reduce the incidence of malpositioning study protocol for a randomized controlled pilot trial
    Trials, 2019
    Co-Authors: Taeha Ryu, Jong Hae Kim, Eugene Kim, Seong Jun Woo, Woon Seok Roh, Sunghye Byun
    Abstract:

    A fiberoptic bronchoscope (FOB) is commonly used to identify the proper placement of a Double-Lumen Endotracheal Tube (DLT) for good lung isolation during thoracic surgery. We hypothesized that the FOB-guided method for DLT placement composed of tracheal intubation under initial guidance by a FOB via the bronchial lumen and subsequent selective left-bronchial intubation could be used to reduce the incidence of DLT malposition and reduce the time required for completion of DLT placement and confirmation of proper DLT position during intubation using a left-sided DLT, in comparison to the conventional method under direct laryngoscopy using a Macintosh laryngoscope. In this randomized controlled pilot trial, 50 patients, aged 18–70 years, scheduled for elective thoracic surgery will be recruited and randomly assigned to two groups according to the method of DLT placement: a FOB-guided method (F) group and a conventional method (C) group. Regardless of the group, the DLT placement processes will be followed by subsequent confirmation processes, using a FOB. If the DLT is misplaced, the position would be corrected. The primary outcome is the incidence of DLT malpositioning observed via a FOB during confirmation after DLT placement. The secondary outcomes consist of the time required to achieve the entire DLT intubation process, which is the sum of the duration of DLT placement and the duration of confirmation of the proper position, the incidence of failed tracheal intubation on the first and second attempt, and complications associated with the intubation process. This pilot study was designed as the first randomized controlled trial to confirm our hypothesis. This should provide information for a further full-scale trial, and the outcomes of the study should provide clinical evidence on the usefulness of the FOB-guided method for DLT placement, in comparison to the conventional method. Clinical Research Information Service; CRIS, ID: KCT0002663 . Retrospectively registered on 24 January 2018.

  • Comparing the placement of a left-sided Double-Lumen Tube via fiberoptic bronchoscopy guidance versus conventional intubation using a Macintosh laryngoscope, to reduce the incidence of malpositioning: study protocol for a randomized controlled pilot trial
    BMC, 2019
    Co-Authors: Taeha Ryu, Jong Hae Kim, Eugene Kim, Seong Jun Woo, Woon Seok Roh, Sunghye Byun
    Abstract:

    Abstract Background A fiberoptic bronchoscope (FOB) is commonly used to identify the proper placement of a Double-Lumen Endotracheal Tube (DLT) for good lung isolation during thoracic surgery. We hypothesized that the FOB-guided method for DLT placement composed of tracheal intubation under initial guidance by a FOB via the bronchial lumen and subsequent selective left-bronchial intubation could be used to reduce the incidence of DLT malposition and reduce the time required for completion of DLT placement and confirmation of proper DLT position during intubation using a left-sided DLT, in comparison to the conventional method under direct laryngoscopy using a Macintosh laryngoscope. Methods/design In this randomized controlled pilot trial, 50 patients, aged 18–70 years, scheduled for elective thoracic surgery will be recruited and randomly assigned to two groups according to the method of DLT placement: a FOB-guided method (F) group and a conventional method (C) group. Regardless of the group, the DLT placement processes will be followed by subsequent confirmation processes, using a FOB. If the DLT is misplaced, the position would be corrected. The primary outcome is the incidence of DLT malpositioning observed via a FOB during confirmation after DLT placement. The secondary outcomes consist of the time required to achieve the entire DLT intubation process, which is the sum of the duration of DLT placement and the duration of confirmation of the proper position, the incidence of failed tracheal intubation on the first and second attempt, and complications associated with the intubation process. Discussion This pilot study was designed as the first randomized controlled trial to confirm our hypothesis. This should provide information for a further full-scale trial, and the outcomes of the study should provide clinical evidence on the usefulness of the FOB-guided method for DLT placement, in comparison to the conventional method. Trial registration Clinical Research Information Service; CRIS, ID: KCT0002663. Retrospectively registered on 24 January 2018

John R Moyers - One of the best experts on this subject based on the ideXlab platform.

  • comparison of a modified double lumen Endotracheal Tube with a single lumen Tube with enclosed bronchial blocker
    Anesthesia & Analgesia, 1996
    Co-Authors: Javier H Campos, Daniel K Reasoner, John R Moyers
    Abstract:

    This study compared the modified BronchoCath[R] Double-Lumen Endotracheal Tube with the Univent[R] bronchial blocker to determine whether there were objective advantages of one over the other during anesthesia with one-lung ventilation (OLV). Forty patients having either thoracic or esophageal procedures were randomly assigned to one of two groups. Twenty patients received a left-side modified BronchoCath[R] Double-Lumen Tube (DLT), and 20 received a Univent[R] Tube with a bronchial blocker. The following were studied: 1) time required to position each Tube until satisfactory, placement was achieved; 2) number of times that the fiberoptic bronchoscope was required; 3) frequency of malpositions after initial placement with fiberoptic bronchoscopy; 4) time required until lung collapse; 5) surgical exposure ranked by surgeons blinded to type of Tube used; and 6) cost of Tubes per case. No differences were found in: 1) time required to position each Tube (DLT 6.2 +/- 3.1 versus Univent[R] 5.4 +/- 4.5 min [mean +/- SD]); 2) number of bronchoscopies per patient (DLT median 2, range 1-3 versus Univent[R] median 3, range 2-5); or 3) time to lung collapse (DLT 7.1 +/- 5.4 versus Univent[R] 12.3 +/- 10.5 min). The frequency of malposition was significantly lower for the DLT [5] compared to the Univent[R] [15] (P < 0.003). Blinded evaluations by surgeons indicated that 18/20 DLT provided excellent exposure compared to 15/20 for the Univent[R] group (P = not significant). We conclude that in spite of the greater frequency of malposition seen with the Univent[R], once position was corrected adequate surgical exposure was provided. In the Univent[R] group the incidence of malposition and cost involved were both sufficiently greater that we cannot find cost/efficacy justification for routine use of this device. (Anesth Analg 1996;83:1268-72)

  • comparison of a modified double lumen Endotracheal Tube with a single lumen Tube with enclosed bronchial blocker
    Anesthesia & Analgesia, 1996
    Co-Authors: Javier H Campos, Daniel K Reasoner, John R Moyers
    Abstract:

    This study compared the modified BronchoCath Double-Lumen Endotracheal Tube with the Univent bronchial blocker to determine whether there were objective advantages of one over the other during anesthesia with one-lung ventilation (OLV). Forty patients having either thoracic or esophageal procedures were randomly assigned to one of two groups. Twenty patients received a left-side modified BronchoCath Double-Lumen Tube (DLT), and 20 received a Univent Tube with a bronchial blocker. The following were studied: 1) time required to position each Tube until satisfactory placement was achieved; 2) number of times that the fiberoptic bronchoscope was required; 3) frequency of malpositions after initial placement with fiberoptic bronchoscopy; 4) time required until lung collapse; 5) surgical exposure ranked by surgeons blinded to type of Tube used; and 6) cost of Tubes per case. No differences were found in: 1) time required to position each Tube (DLT 6.2 +/- 3.1 versus Univent 5.4 +/- 4.5 min [mean +/- SD]); 2) number of bronchoscopies per patient (DLT median 2, range 1-3 versus Univent median 3, range 2-5); or 3) time to lung collapse (DLT 7.1 +/- 5.4 versus Univent 12.3 +/- 10.5 min). The frequency of malposition was significantly lower for the DLT (5) compared to the Univent (15) (P < 0.003). Blinded evaluations by surgeons indicated that 18/20 DLT provided excellent exposure compared to 15/20 for the Univent group (P = not significant). We conclude that in spite of the greater frequency of malposition seen with the Univent, once position was corrected adequate surgical exposure was provided. In the Univent group the incidence of malposition and cost involved were both sufficiently greater that we cannot find cost/ efficacy justification for routine use of this device.

Yves Lacasse - One of the best experts on this subject based on the ideXlab platform.

  • bronchial blocker versus left double lumen Endotracheal Tube in video assisted thoracoscopic surgery a randomized controlled trial examining time and quality of lung deflation
    Canadian Journal of Anaesthesia-journal Canadien D Anesthesie, 2016
    Co-Authors: Jean S Bussieres, Jacques Somma, Paula A Ugalde, Jerome Lemieux, Jose Luis Carrasco Del Castillo, Massimo Conti, Nathalie Gagne, Yves Lacasse
    Abstract:

    Introduction Double-Lumen Endotracheal Tubes (DL-ETT) and bronchial blockers (BB) have both been used for lung isolation in video-assisted thoracic surgery (VATS). Though not well studied, it is widely thought that a DL-ETT provides faster and better quality lung collapse. The aim of this study was to compare a BB technique vs a left-sided DL-ETT strategy with regard to the time and quality of lung collapse during one-lung ventilation (OLV) for elective VATS.

  • bronchial blocker versus left double lumen Endotracheal Tube in video assisted thoracoscopic surgery a randomized controlled trial examining time and quality of lung deflation
    Canadian Journal of Anaesthesia-journal Canadien D Anesthesie, 2016
    Co-Authors: Jean S Bussieres, Jacques Somma, Paula A Ugalde, Jerome Lemieux, Jose Luis Carrasco Del Castillo, Massimo Conti, Nathalie Gagne, Yves Lacasse
    Abstract:

    Double-Lumen Endotracheal Tubes (DL-ETT) and bronchial blockers (BB) have both been used for lung isolation in video-assisted thoracic surgery (VATS). Though not well studied, it is widely thought that a DL-ETT provides faster and better quality lung collapse. The aim of this study was to compare a BB technique vs a left-sided DL-ETT strategy with regard to the time and quality of lung collapse during one-lung ventilation (OLV) for elective VATS. Forty patients requiring OLV for VATS were randomized to receive a BB (n = 20) or a left-sided DL-ETT (n = 20). The primary endpoint was the time from pleural opening (performed by the surgeon) until complete lung collapse. The time was evaluated offline by reviewing video recorded during the VATS. The quality of lung deflation was also graded offline using a visual scale (1 = no lung collapse; 2 = partial lung collapse; and 3 = total lung collapse) and was recorded at several time points after pleural incision. The surgeon also graded the time to complete lung collapse and quality of lung deflation during the procedure. The surgeon’s guess as to which device was used for lung isolation was also recorded. Of the 40 patients enrolled in the study, 20 patients in the DL-ETT group and 18 in the BB group were analyzed. There mean (standard deviation) time to complete lung collapse of the operative lung was significantly faster using the BB compared with using the DL-ETT [7.5 (3.8) min vs 36.6 (29.1) min, respectively; mean difference, 29.1 min; 95% confidence interval, 1.8 to 7.2; P < 0.001]. Overall, a higher proportion of patients in the BB group than in the DL-ETT group achieved a quality of lung collapse score of 3 at five minutes (57% vs 6%, respectively; P < 0.004), ten minutes (73% vs 14%, respectively; P = 0.005), and 20 min (100% vs 25%, respectively; P = 0.002) after opening the pleura. The surgeon incorrectly guessed the type of device used in 78% of the BB group and 50% of the DL-ETT group (P = 0.10). The time and quality of lung collapse during OLV for VATS was significantly better when using a BB than when using a left-sided DL-ETT. Surgeons could not reliably determine which device was being used based on the time and quality of lung collapse. This trial was registered at ClinicalTrials.gov number, NCT01615263.

Kemp H Kernstine - One of the best experts on this subject based on the ideXlab platform.

  • devices for lung isolation used by anesthesiologists with limited thoracic experience comparison of double lumen Endotracheal Tube univent torque control blocker and arndt wire guided endobronchial blocker
    Anesthesiology, 2006
    Co-Authors: Javier H Campos, Ezra A. Hallam, Timothy L Van Natta, Kemp H Kernstine
    Abstract:

    Background: Lung isolation is accomplished with a Double-Lumen Tube or a bronchial blocker. Previous studies comparing lung isolation methods were performed by experienced anesthesiologists in thoracic anesthesia. Therefore, the results of these studies may not be relevant to the anesthesiologist with limited experience. This study compared the success rates of lung isolation devices among anesthesiologists with limited experience in thoracic anesthesia. Methods: A prospective, randomized trial was designed to determine the success and time required for proper placement of the left-sided Double-Lumen Tube (n = 22), the Univent® Tube (Vitaid Ltd., Lewiston, NY; n = 22), and the Arndt Blockers (Cook Critical Care, Bloomington, IN; n = 22). Anesthesiologists with less than two lung isolation cases per month were included (faculty n = 17 and senior residents n = 11). Variables recorded included (1) successful placement (as determined by an independent observer), (2) time of placement, and (3) the number of times the fiberoptic bronchoscope was used. Results: Participants failed to place or position their assigned device in 25 of 66 patients (failure was 39% among faculty and 36% among senior residents). The failure rate did not differ among the three devices (P = 0.65). The median (25th-75th percentile) times to complete the placement procedures were as follows: (1) Double-Lumen Tube: 6.1 min (4.6-9.5 min), (2) Univent Tube: 6.7 min (4.9-8.8 min), and (3) Arndt Blocker: 8.6 min (5.8-17.5 min) (P = 0.45 comparing all devices). After device malposition was identified, it took 1 min or less for the investigating anesthesiologist to achieve optimal position. Conclusions: Anesthesiologists with limited experience in thoracic anesthesia frequently fail to successfully place lung isolation devices. Rapid successful device placement by an experienced anesthesiologist excluded any contribution of uniquely difficult anatomy. The nature of the malpositions suggests that the most critical factor in successful placement was the anesthesiologist's knowledge of endoscopic bronchial anatomy.

  • use of the wire guided endobronchial blocker for one lung anesthesia in patients with airway abnormalities
    Journal of Cardiothoracic and Vascular Anesthesia, 2003
    Co-Authors: Javier H Campos, Kemp H Kernstine
    Abstract:

    ONE-LUNG VENTILATION (OLV) in the thoracic surgical patient can be achieved with the use of a Double-Lumen Endotracheal Tube (DLT) or bronchial blockade with a Univent Tube (Vitaid LTD, Lewiston, NY), a Fogarty occlusion catheter (Edwards Lifesciences, Irvine, CA), or a wire-guided endobronchial blocker (Arndt blocker; Cook Critical Care, Bloomington, IN).1,2 OLV techniques may be complicated in these patients because of the uncommon occurrence of carcinoma of the pharynx, tongue, or epiglottis, which makes intubation difficult. In addition, some of these patients have received prior neck radiation therapy and extensive neck/tracheal surgery. All of these problems make the airway management more complex and challenging. The authors report 4 cases in which the upper and/or lower airway anatomy have been previously distorted because of surgery or radiation; in all cases successful OLV was achieved with the use of the Arndt blocker.

  • a comparison of a left sided broncho cath with the torque control blocker univent and the wire guided blocker
    Anesthesia & Analgesia, 2003
    Co-Authors: Javier H Campos, Kemp H Kernstine
    Abstract:

    Lung isolation can be accomplished in two ways: the first, a Double-Lumen Endotracheal Tube (DLT) and the second, a bronchial blocker (Univent® or Arndt® blocker). Previous studies have found that the DLT and the Univent® are comparable when providing lung isolation. A new bronchial blocker, the wir