Retrospective evaluation of the use of left sided double-lumen endobronchial tubes with an embedded camera VivaSight-DL® during lung separation in 30 thoracic surgery patients

34TH EACTA ANNUAL CONGRESS ABSTRACTS / Journal of Cardiothoracic and Vascular Anesthesia 33 (2019) S105 S139

PP.01.19 Retrospective evaluation of the use of left sided double-lumen endobronchial tubes with an embedded camera VivaSight-DLÒ during lung separation in 30 thoracic surgery patients

M. Granell Gil1, I. Carrasco2, P. Kot3, M. Murcia1, J. Morales1, A. Broseta1, R. Guijarro1, J.A. de Andres1 1

Consorcio Hospital General Universitario, Medicine (University), Valencia, Spain 2 Medicine (University), Valencia, Spain 3 Consorcio Hospital General Universitario, Valencia, Spain Introduction: Lung isolation is essential in thoracic surgery, specially to achieve a lung resection. Left sided double-lumen endobronchial tubes with an embedded camera (VTDL) VivaSight-DLÒ allow the airway’s management and its continuous visualization on a portable external monitor as well as onelung isolation during anesthetics procedures1. It might be useful in thoracic surgery. Although nowadays the fiberoptic bronchoscopy (FBS) is the “gold standard” to verify the position of endobronchial tubes, the VTDL might become an alternative2. The purpose of this study is to review whether the VTDL reduces or overrides the need for FBS for verification of the endobronchial tube’s placement during intubation. Methods: Retrospective descriptive and longitudinal study during 14,5 months in the CHGUV for patients who underwent lung resection procedures with VTDL VivaSight-DLÒ for onelung isolation. Data collected included: sex, age, body mass index, Mallampati, Cormack-Lehane, ASA risk, difficult intubation, airway’s management, FBS use, VTDL size, PEEP, SpO2, FiO2, ETCO2, peak flow, hospital stay, complications, re-admission and mortality. Results: 30 patients who underwent lung resection procedures using VTDL were included. The age average was 66’27§ 1,65 years. The VTDL was used with direct laryngoscope.

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Neither of them needed FBS. The intraoperative respiratory parameters were optimal (Fig. 1. TLV: two lung ventilation, OLV: one lung ventilation). The average time of stay in ICU was 1,41 § 0,45 days and the total hospital stay 6,23 § 0,83 days. There was 1 re-admission in ICU, 2 in hospital and 11 complications. Survival rate was 100%. Discussion: Lung isolation is very important in thoracic surgery. Left sided double-lumen endobronchial tubes with an embedded camera (VTDL) VivaSight-DLÒ allow the airway’s management and its continuous visualization on a portable external monitor as well as one-lung isolation during anesthetics procedures1. It might be useful in thoracic surgery because some studies concludes that this device is useful to check the double lumen insertion and its displacements during the changes of position of the thoracic patients or during the thoracic surgical procedure 2. Perhaps the FBS is now no so necessary as in the past but we needed more studies to analyze this situation. REFERENCES: 1. Saracoglu A, Saracoglu KT. VivaSight: A new era in the evolution of tracheal tubes. J Clin Anesth. 2016;33(2016):442-9. 2. Heir JS, Guo SL, Purugganan R, Jackson TA, Sekhon AK, Mirza K, et al. A randomized controlled study of the use of video double-lumen endobronchial tubes versus double-lumen endobronchial tubes in thoracic surgery. J Cardiothorac Vasc Anest. 2018;32(1):267-74.

PP.01.20 Diagnostic pitfalls: unexpectedly severe pulmonary hypertension with pulmonary hemorrhage after atrial septal defect closure - a case report

G. Gazivoda1, M. Kontic1, M. Jovic1,2 1 2

Cardiovascular Institute Dedinje, Belgrade, Serbia School of Medicine, University of Belgrade, Belgrade, Serbia

Introduction: Certain elderly patients may suffer from an uncorrected congenital heart disease (CHD) and severe pulmonary hypertension (PHT). Methods: A 69-year-old male patient presented for elective surgical closure of an atrial septal defect (ASD) and for a radiofrequency (RF) ablation of the pulmonary veins due to frequent episodes of atrial fibrillation. A transthoracic echocardiography revealed a small defect in the middle part of the atrial septum with a pulmonary to systemic blood flow ratio of 3:1 and a right ventricle (RV) systolic pressure of 45 mmHg. Results: Following the cardiopulmonary bypass institution, surgical inspection detected a sinus venosus defect with anomalous drainage of the right upper pulmonary vein into the left atrium, apart from the ASD type secundum. A pericardial patch reconstruction and Cox-Maze IV procedure was performed. Several hours after the intervention, blood was