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Javier H Campos

Publications and source records attributed to Javier H Campos.

12 recordsLinked to original sources
PubMed2007

Which device should be considered the best for lung isolation: double-lumen endotracheal tube versus bronchial blockers.

PURPOSE OF REVIEW: This review is a clinical comparison between double-lumen endotracheal tubes and bronchial blockers to determine which device is considered the best for lung isolation. RECENT FINDINGS: Double-lumen endotracheal tubes and bronchial blockers have been found to be clinically equivalent in terms of performance in providing lung collapse for patients with normal airways. In the last five years, however, numerous reports have indicated a preference for the use of bronchial blockers in patients with airway abnormalities. For nonthoracic anesthesiologists who have limited experience in thoracic anesthesia cases, none of the devices (double-lumen tubes or bronchial blockers) have been shown to provide any advantage while in use due to a high incidence of unrecognized malpositions. Overall, each device provides advantages depending upon the case, such as absolute lung separation with a double-lumen endotracheal tube or the use of a bronchial blocker in a difficult airway for a patient requiring lung isolation. SUMMARY: Double-lumen endotracheal tubes and bronchial blockers should be part of the armamentarium of every anesthesiologist involved in lung isolation techniques and every device should be tailored to specific case needs.

Bronchi↗
PubMed2006

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.

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 Blocker (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.

Adult↗
PubMed2005

Progress in lung separation.

The progress in lung separation technology has allowed anesthesiologists to become skillful in fiberoptic bronchoscopy techniques and to provide excellent lung exposure in thoracic surgery patients. Given the availability of two technologies--DLTs (right-sided and left-sided) and bronchial blocker technology (TCBU, Arndt, and Cohen--every case that requires lung collapse and OLV should receive the benefit of these devices. Because of its greater margin of safety, a left-sided DLT is the more common device used in lung separation. If any contraindication to placing a left-sided DLT exists, a right-sided DLT is an option for any specific situation (eg, left lung transplantation). For a patient who requires lung separation and presents with the dilemma of a difficult or abnormal airway, bronchial blockers offer more advantages. Regardless of the device used, the optimal position of these devices (DLTs and bronchial blockers) is achieved best with the use of fiberoptic bronchoscopy techniques first in supine and then in lateral decubitus position or whenever repositioning of the device is needed.

Anesthesia, General↗
PubMed2004

Noncardiac pulmonary, endocrine, and renal preoperative evaluation of the vascular surgical patient.

Patients who have vascular disease who are to undergo an operation are at risk for developing perioperative and postoperative complications caused by coexisting diseases. A comprehensive preoperative evaluation is critical in identifying these coexisting diseases, and the anesthetic plan might require modification. This article focuses on important aspects of the pulmonary, endocrine (diabetes), and renal systems during the preoperative evaluation of the vascular surgical patient.

Animals↗
PubMed2003

A comparison of a left-sided Broncho-Cath with the torque control blocker univent and the wire-guided blocker.

UNLABELLED: 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 wire-guided endobronchial blocker (Arndt blocker), has been introduced. However, there is no study to report its effectiveness with lung isolation during elective thoracic surgical cases. Therefore, we designed a prospective, randomized trial to compare the effectiveness of lung isolation among the 3 endotracheal tubes: the left-sided DLT Broncho-Cath Group A (n = 16 patients), the torque control blocker Univent Group B (n = 16 patients), and the wire-guided Arndt blocker Group C (n = 32 patients). The following variables were recorded: 1) time to initially position the assigned tube, 2) frequency of malpositions, 3) frequency of use of fiberoptic bronchoscope, 4) overall surgical exposure, and 5) tube acquisition cost. The Arndt blocker took longer to place (3:34 min/s) compared with the other 2 groups: the DLT group (2:08 min/s) or the Univent group (2:38 min/s) (P < 0.0004). There was no statistical difference in tube malpositions among the three groups: two for the DLT group, four for the Univent group, and nine in the Arndt group. Excluding the time for tube placement, the Arndt group also took longer for the lung to collapse (26:02 min/s), compared with the DLT group (17:54 min/s) or Univent group (19:28 min/s) (P < 0.0060). Furthermore, unlike the other two groups, the majority of the Arndt patients required suction to achieve lung collapse. Once lung isolation was achieved, overall surgical exposure was rated excellent for the three groups. Acquisition cost for the DLT group was $1663.20 (21 tubes opened), $2329.00 for the Univent group (17 tubes opened), and $3567.00 for the Arndt group (33 wire-guided blockers opened). This study demonstrates that the Arndt blocker takes longer to position and longer to deflate the isolated lung. For elective thoracic surgical cases, once the lung was isolated, the management seemed to be similar for all three tube groups. IMPLICATIONS: We compared the latest design of double-lumen tubes Broncho-Cath, Univent, and Arndt blockers during lung isolation. Our results show that the Arndt blocker takes longer to position and longer to deflate the isolated lung. Once the lung was isolated, the management seemed to be similar for all three devices.

Adult↗
PubMed2003

An update on bronchial blockers during lung separation techniques in adults.

Techniques for one-lung ventilation (OLV) can be accomplished in two ways: The first involves the use of a double-lumen endotracheal tube (DLT). The second involves blockade of a mainstem bronchus (bronchial blockers). Bronchial blockade technology is on the rise, and in some specific clinical situations (e.g., management of the difficult airway during OLV or selective lobar blockade) it can offer more as an alternative to achieve OLV in adults. Special emphasis on newer information for the use of Fogarty embolectomy catheter as a bronchial blocker, the torque control blocker Univent, and the wire-guided endobronchial blocker (Arndt blocker) is included. Also this review describes placement, positioning, complications, ventilation modalities, and airflow resistances of all three bronchial blockers. Finally, the bronchial blockers can be used in many cases that require OLV, taking into consideration that bronchial blockers require longer time for placement, assisted suction to expedite lung collapse, and the use of fiberoptic bronchoscopy. The current use of bronchial blockers, supported by scientific evidence, dictates that bronchial blockers should be available in any service that performs lung separation techniques.

Adult↗