Prospective Randomized Study on Video Double-Lumen Tube Versus Double-Lumen Tube
Phase: PHASE3
Conditions: Other Surgical Procedures
Sponsor: M.D. Anderson Cancer Center

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Prospective Randomized Study on 
Video Double-Lumen Tube versus Double-Lumen Tube 
 
Principal Investigator: Dr. Jagtar Singh Heir 
Co-Investigator: Dr. Juan Cata 
Collaborators: Drs. Reza Mehran, David Rice, Kazim Mirza, Piotr Kwater, Ron 
Purugganan, Tim Jackson, Teresa Moon, Shital Vachhani, Javiar Lasala, Elena 
Potylchansky, Dilip Thakar, January Tsai, Peter Norman, Shu-Lin Guo 
Bio-statistician Collaborator: Lei Feng 
 
 
Contents 
1.0 Background 
2.0 VDLT and DLT Information 
3.0 Study Endpoints 
4.0 Patient Eligibility 
5.0 Treatment Plan 
6.0 Other Data to be Collected 
7.0 Statistical Considerations 
8.0 Adverse Events and Reporting 
9.0 Data Confidentiality Plan 
10.0 Appendix 
11.0 References 
 
 
 
1.0 
Background 
1.1 
Lung Isolation For Thoracic Surgery 
In the 1930’s, lung isolation became possible with the introduction of 
single lumen endobronchial tubes, as well as endobronchial blockers. 
Thereafter, Carlens invented a double lumen tube (DLT) with a carinal 
hook in 1949, to assist in bronchial placement so that proper lung isolation 
could be maintained.1 This landmark development in lung isolation 
allowed placement of the endotracheal tube without necessitating a rigid 
bronchoscopy, which had always been previously required. However, this 
type of equipment essentially required significant experience in order to 
achieve successful lung isolation.  
 
Furthermore, this carinal hook was also the source of increased airway 
trauma, as the hook could potentially break off in the airway leading to 
malposition, as well as a foreign body in the airway. However, White then 
modified the Carlens tube by creating a right-sided version, also with a 
carinal hook, which was easier to place. Thereafter in 1962, Robertshaw 
introduced a reusable red rubber DLT without a carinal hook.2 In addition 

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to the reusability component, the right-sided red rubber Robertshaw DLT 
had a larger 22mm slotted endobronchial cuff for improved right upper 
lobe (RUL) ventilation.  
 
Subsequently, in the 1970's the primary airway device used for lung 
isolation in the United States was the DLT. However, the Robertshaw 
DLTs had their own unique problems: small internal channels, which made 
suction difficult as well as low volume-high pressure bronchial cuffs, which 
could lead to tracheal mucosa ischemia via compression. In the 1980's, 
disposable polyvinylchloride (PVC) DLTs were created, which remain the 
mainstay of DLTs used currently for lung isolation.  These PVC DLTs have 
the advantage of high volume-low pressure tracheobronchial cuffs which 
inflate more evenly thus significantly decreasing the chances of mucosal 
ischemia.  Furthermore, these PVC DLTs are easier to manipulate and 
place, while also offering larger internal lumens for suction and fiberoptic 
(FOB) scope placement, which is used to verify correct placement. 
 
Throughout the development of DLTs and other lung isolation devices, the 
capability for direct visualization to insure correct placement of these 
devices has always been a major limiting factor for their use.  Proper 
placement is paramount to patient safety and device effectiveness.  The 
development and refinement of flexible fiberoptic bronchoscopes offered 
an alternative, more reliable method than auscultation for proper 
placement of airway isolation devices. 
 
1.2 
Impact on Patient Outcomes  
The use of a pediatric FOB scope was only first described in 1982 by 
Watson, as practitioners had noted improper placement could still occur 
despite inspection and auscultation. Hence in the United States, FOB 
verification is considered the current standard of care. There are multiple 
studies that support the use of FOB to confirm DLT placement. 
For example, one study found that despite normal findings on auscultation 
and inspection, 39% (79) of these patients had DLT malposition 
diagnosed by FOB.3 Moreover, of the 79 patients with malposition, 25 
were critical malpositions. Additionally, DLTs were malpositioned as often 
after positioning the patient for lateral thoracotomy (46%) as they were 
after intubation (53%). Similarly, yet another study found that auscultation 
failed to confirm accurate tube position in 28% of L DLT patients. 78% of 
left DLT patients and 83% of right DLT patients, who were intubated 
blindly, required repositioning with FOB.4 Likewise, a third study found 
44% of DLTs required position readjustments using FOB during initial 
intubation and 30% required FOB readjustments during the operation.5   
 
Although the FOB has become the standard of care for confirmation of 
DLT, unfortunately many anesthesiologists lack the training and familiarity 
of tracheobronchial anatomy for adequate application of this technique, 

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leading to a high incidence (38%) of malposition despite the use of FOB.6 
Furthermore, a limitation common to existing comparative studies is that 
all these studies were conducted by anesthesiologists with particular 
interest and expertise in thoracic anesthesia, who perform lung isolation 
procedures on a routine basis. However, in many practices, lung isolation 
is an uncommon procedure and is performed by anesthesiologists who do 
not specialize in thoracic anesthesia. In addition, lung isolation is needed 
for many procedures performed outside of the regular thoracic surgical 
suite and hence is performed by clinicians with less experience.  
Therefore, potentially the results of malposition and incorrect placement 
could conceivably be higher in the practices of these non-thoracic 
anesthesiologists.  
 
Yet, another issue that limits the use of fiberoptic bronchoscopy is 
availability. Fiberoptic bronchoscopes are precision instruments that are 
costly to acquire and maintain.  Because of the expenditure involved, 
smaller community health care centers and/or poorly funded hospitals may 
lack funding to acquire fiberoptic bronchoscopes. As there is an increasing 
demand for one-lung ventilation in both thoracic surgery and other 
procedures  (i.e. spine surgery, cardiac surgery), identifying the most 
effective technique of lung isolation for anesthesiologists with limited 
experience in lung isolation techniques, would benefit to improve the 
safety for patients.   
 
One such technologic advance has been in video camera and light source 
miniaturization, which may offer a novel solution to this problem. The 
VivasightTM (ET ViewLtd,Misgav,Israel)DLT is a video double-lumen 
tube(VDLT) that has an embedded camera and light source between  the 
tracheal and bronchial cuffs, enabling continuous airway visualization on a 
portable external proprietary monitor that is connected via a mini-USB 
adapter.  Heir and colleagues evaluated whether the use of a VDLT 
reduced the need for fiberoptic bronchoscopy for (1) verification of initial 
tube placement and for (2) reverification of correct placement after 
repositioning for thoracotomy.7 The study found that for 93.2% of patients, 
the use of FOB was not needed either for initial placement or for 
verification of correct VDLT placement upon final positioning of the patient. 
This study demonstrated that the VDLT requires significantly less (6.8%) 
FOB use for both initial placement and verification of final position, in stark 
contrast to standard practice in which bronchoscopy is always used to 
verify final positioning of the double-lumen tube.   
 
Furthermore, the authors also noted that the continuous real time 
monitoring allowed for greater measure of safety, as they were able to 
forewarn the surgeon when aggressive manipulation would otherwise 
have led to a malposition. Furthermore, the real time image provided by 
the embedded camera, could potentially allow for quick diagnosing of the 

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problem, hence enabling the provider to institute proper therapy in more 
timely fashion.  Likewise, VDLT could provide an additional measure of 
safety in procedures such as pneumonectomies, where it is desired to 
move the DLT before the surgeon clamps the bronchus, allowing 
visualization of the stapling that avoids inadvertent stapling of the tube into 
the bronchial stump or rupturing of the endobronchial cuff of the DLT.  
 
Although the FOB remains the gold standard for examination of the 
tracheobronchial tree, the embedded camera view can be used as an 
adjunct to teach trainees to recognize and become more familiar with the 
anatomy via direct visualization.  This concept could also be useful for the 
anesthesiologist who does not use DLTs on a regular basis and is more 
likely to employ the blind advancement technique when placing a DLT. 
 
1.3 
Current Standard of Care 
In centers across North America, FOB use is employed as the current 
standard for verification of DLT placement.  However, there are 
institutions, which still promote auscultation as viable method of DLT 
placement confirmation, as FOB may not always be available and trainees 
need to be able to properly position a DLT in less than ideal 
circumstances (off-site locations, broken equipment, etc).  However, even 
in most of these cases, this does not preclude that the tube position 
cannot then be confirmed with FOB, after the staff and/or resident have 
checked initially with auscultation. 
 
Furthermore, consideration has to be given to the fact that even with the 
use of FOB, correct tube position is not always obvious. There is a 
considerable learning curve to bronchoscopic positioning of double-lumen 
tubes, particularly when there are anatomic distortions because of tumor 
masses or previous surgery; analogous to anesthesiologists examining 
hundreds of routine airways to become comfortable with the airway 
anatomy. Therefore, correct placement of a DLT can be challenging and 
hence lung isolation may become difficult to achieve. Novel intubation 
devices like the VDLT have been developed that offer real-time 
continuous observation of the trachea and carina, thus allowing the 
anesthesiologist to confirm continuous correct placement and also 
recognize dislodgement. 
  
In addition, displacement and dislodgement of DLT is common and 
repeated checks for correct positioning with a FOB are often necessary. In 
some cases these frequent checks can interfere with oxygenation and 
ventilation, which may pose a considerable risk to the patient. This 
potentially may be detrimental, as this can lead to hypoxemia and 
prolongation of the surgical procedure. Thus these newer intubation 
devices can offer continuous observation of the trachea and carina and 

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thereby reduce the need for a FOB during tube placement and 
subsequent airway monitoring. 
 
 
2.0 
VDLT  and DLT Information 
2.1 
Description of VDLT 
2.1.1 The VDLT is essentially a FDA approved disposable, single use 
left-sided double lumen endobronchial tube with an embedded 
video imaging device and light source at its distal tip and integrated 
cable with connector. The device is compatible with ETview’s 
displays and with medical grade NTSC video monitors.  The VDLT 
projects images of the airway onto the monitor screen during 
intubation and for as long as the device remains within the patient’s 
airway.  (See Appendix 3) 
2.1.2 The VDLT is made of PVC transparent material, with two low-
pressure cuffs and two color-coded, corresponding pilot balloons. 
The tracheal cuff with clear pilot balloon and the bronchial cuff with 
blue pilot balloon.  The valves are intended for Luer and Luer-lock 
syringe tips.  It also comes with a stylet, which can be fixed to 
maintain the shape of the tube, as well as radiopaque intubation 
depth markers, which run along the tube’s wall.  Additionally, it has 
a red injection port leading to two lumens running along the tube’s 
wall that open distal to the lens of the optics which can be used for 
cleaning the lens with air, saline or prescribed medications. 
2.1.3 Accessories:  The VDLT comes with a Y-piece plastic connector 
intended to connect to the breathing circuit.  A small malleable 
metal stylet is also provided with the VDLT. It also comes with two 
suction catheters, which can be inserted in the tracheal or bronchial 
lumens to clear secretions. 
2.1.4 Thermal qualities:  The VDLT should not be used in surgical 
procedures that involve the use of a LASER beam near the VDLT.  
The VDLT should not be stored at temperatures greater than 42 
degrees Celsius.  
2.2 
Description of DLT 
2.2.1 The DLT is a double lumen endobronchial tube that allows the 
anesthesiologist to preferentially ventilate one or both lungs, 
enabling lung isolation for the proposed surgery. The device comes 
in both left and right-sided versions. (See Appendix 4) 
2.2.2 The DLT is also made of PVC transparent material, with two low-
pressure cuffs and two color-coded, corresponding pilot balloons. 
The tracheal cuff with clear pilot balloon and the bronchial cuff with 
blue pilot balloon.  The valves are intended for Luer and Luer-lock 
syringe tips.  It also comes with a stylet, which can be fixed to 
maintain the shape of the tube, as well as radiopaque intubation 
depth markers, which run along the tube’s wall.  

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2.2.3 Accessories:  The VDLT comes with a Y-piece plastic connector 
intended to connect to the breathing circuit.  A small malleable 
metal stylet is also provided with the VDLT. It also comes with two 
suction catheters, which can be inserted in the tracheal or bronchial 
lumens to clear secretions. 
  
 
 
3.0 
Study Endpoints 
3.1 
Primary endpoint  
3.1.1 Determine the rate of fiberoptic use with the VDLT during surgeries 
requiring lung isolation and to compare to the rate of FOB use with 
the conventional DLT.  
3.2 
Secondary Objectives 
3.2.1 Determine any potential reduction of cost: VDLT vs. acquisition, 
use, maintenance, and repair of FOB systems  
3.2.2 Determine the incidence of malposition:  VDLT vs. DLT  
3.2.3 Compare quality of view provided by the VDLT (embedded camera) 
vs. DLT (FOB) using grading system: (See Appendix 1 attached)  
3.2.4 Determine the number of times secretions need to be 
cleared/flushed for either VDLT (embedded camera) and DLT 
(FOB) 
3.2.5 Determine the efficacy of technique used for clearing secretions for 
VDLT (embedded camera) and DLT (FOB): Yes or No 
3.2.6 Determine difficulties when inserting the VDLT or DLT (See 
Appendix 2 attached)  
3.2.7 Determine the number of times anesthesiologist was able to 
forewarn/ anticipate dislodging or malposition 
3.2.8 Assess the times from initiation of intubation to ready to position, 
and ready for surgical intervention 
 
 
 
4.0 
Patient Eligibility 
4.1 
Inclusion Criteria 
To be eligible for participation in the study patients must meet all of the 
following criteria 
4.1.1 Patients need lung isolation for purposed surgery  
4.1.2 18 years or older 
4.1.3 All patients to give written informed consent to participate 
 
4.2 
Exclusion Criteria 
Patients with any of the following will not be eligible for enrollment 
4.2.1 Patients with known tracheobronchial anatomical anomalies 
4.2.2 Patients requiring emergency operations  
4.2.3 Patients with known difficult airways  

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4.2.4 Patients where other lung isolation devices may be warranted 
(tracheostomy, nasal intubation) 
4.2.5 Patient requiring sizes not available in DLT or VDLT 
4.2.6 Patients requiring a right sided VDLT or DLT 
 
 
 
5.0 
Treatment Plan 
5.1 
Design: 2-arm, randomized prospective trial 
5.2 
Randomization:  Patients will be randomized in a group that utilizes 
either a conventional DLT or VDLT for lung isolation for the purposed 
surgery. Patients will undergo surgical procedure after lung isolation is 
acquired with VDLT or DLT. The patients will undergo surgical procedures 
that are part of their medical treatment and will not undergo any diagnostic 
or extra laboratory work as a result of participating in this study 
5.3 
Explanation of Thoracic Anesthesia Intervention 
 
One of the collaborating thoracic anesthesiologists will explain the 
procedure prior to obtaining consent. Consent and randomization will 
occur at minimum one hour prior to surgery. Randomization will be done 
after consent and by a computerized system. 
5.4 
Withdrawal of individual subjects:  
Subjects can leave the study at any time for any reason if they wish to do 
so without any consequences. The investigator can decide to withdraw a 
subject from the study for urgent medical reasons. 
5.5 
Specific criteria for withdrawal (if applicable)  
 
Not applicable  
5.6 
Replacement of individual subjects after withdrawal  
 
Not applicable  
5.7 
Follow-up of subjects withdrawn from treatment  
 
Not applicable  
5.8 
Premature termination of the study  
 
Not applicable 
5.9 
Post discharge Dosing 
 
Not applicable  
5.10 Intraoperative and Postoperative Anesthesia Care  
In the preoperative holding area, patients will receive intravenous 
midazolam if clinically indicated according to the anesthesiologist’s 
judgment. Prophylactic antibiotics will be given per surgical routine.  A 
balanced anesthetic technique comprising of narcotics, muscle relaxants, 
inhalational will be utilized to induce and maintain general anesthesia for 
all patients undergoing thoracic surgery.   
 
General anesthesia will be induced with fentanyl or sufentanil and propofol 
intravenously according to the anesthesiologist’s clinical judgment. 
Tracheal intubation will be facilitated by succinylcholine or a 
nondepolarizing muscle relaxant. Anesthesia will be maintained with 

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desflurane, sevoflurane or isoflurane in (50%–100%) oxygen or propofol 
infusion according to the anesthesiologist’s clinical judgment. 
Intraoperative analgesia will be obtained by the intravenous administration 
of sufentanil, fentanyl or hydromorphone.  
 
Alternatively, an epidural can also be utilized intraoperatively, according to 
the anesthesiologist’s clinical judgment if an epidural has been placed. 
Hemodynamics will be maintained according to the clinical 
anesthesiologist’s judgment. Normothermia will be maintained with forced-
air warming. Antiemetics will be given according to the anesthesiologist’s 
clinical judgment. In those patients deemed to be awakened from general 
anesthesia when surgery is complete, muscle relaxation will be reversed 
and the trachea extubated.  
At the end of surgery, hydromorphone or fentanyl will be given 
intravenously if considered necessary for pain control. In the postoperative 
care unit, patients may receive intravenous boluses of fentanyl, 
hydromorphone, or boluses of epidural infusion for postoperative pain 
control. In those patients for whom sedation and admission to the 
intensive care unit is necessary, intravenous propofol will be given 
continuously during transport.  
 
With respect to achievement of lung isolation for the proposed thoracic 
surgeries, patients will either be randomized to the DLT or VDLT group.  In 
either scenario, the DLT or VDLT will be inserted with conventional 
laryngoscopy or video-laryngoscopy by a member of the thoracic 
anesthesia team.  Once correct placement has been thought to be 
achieved, the final position will be verified confirmed in the following ways:  
in the DLT group, final position will be verified with FOB and in the VDLT 
group, the final position will be verified with the embedded camera, 
however, at the discretion of the anesthesiologist the FOB may be used to 
also verify final position, as long it is recorded in the chart. 
 
6.0  
Other Data to be Collected  
Research staff will collect demographic and clinical information from the patient's 
medical record. Demographic data to be collected may include such items as 
birth date and race/ethnicity. Examples of clinical information that may be 
collected at one or more time points during the study include height and weight, 
disease information (e.g., cancer site/stage), treatment information (e.g., type of 
surgery, postsurgical status, current medications), comorbidities, and 
performance status.  
 
 
7.0  
Statistical Considerations    
The primary objective is to determine the rate of FOB use with the VDLT during 
surgeries requiring lung isolation and to compare to the rate of FOB use with the 
conventional DLT. The rate of FOB use with the conventional double lumen tube 

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is known to be 100%.  We plan to enroll 80 patients for the study with 40 patients 
each arm.  The study will have 99% power (Scenario #1 in the table below) to 
detect the difference in the rate of FOB use between 20% for the new video 
double lumen tube arm and 99% for the conventional double lumen tube arm, 
assuming a two-sided type error rate of 0.05 (nQuery Advisor 7.0). 
 
Power calculations based on different scenarios of rate of FOB use are provided 
in the table below. 
 
Assumption: two-sided α=0.05, and the rate of FOB use with the conventional 
double lumen tube=0.99 (the software requires the rate to be less than 1). 
 
Scenario 
Rate of 
fiberoptic use 
with VDLT 
power 
1 
0.20 
99% 
2 
0.30 
99% 
3 
0.40 
99% 
4 
0.50 
99% 
5 
0.60 
99% 
6 
0.70 
96% 
7 
0.80 
80% 
  
Frequency counts and percentages will be reported for categorical variables 
(such as gender, race, device used for intubation, and incidence of malposition). 
Summary statistics such as number of non-missing observations (N), mean, 
median, standard deviation (std. dev), and range will be provided for continuous 
variable (such as age, time measured in minutes from intubation to ready to 
position, and time from intubation to ready for surgical intervention).  The rate of 
FOB use and its 95% confidence interval for the new video double lumen tube 
arm and the conventional double lumen tube arm will be calculated.  Fisher’s 
exact test or Chi-square test will be used to evaluate the difference in the rate of 
FOB use between the two arms.  Logistic regression may be used to assess the 
association between FOB use and other patient demographic and surgical 
characteristics.   
Analysis results in an aggregated format will be provided to Dr. Shu-Lin Guo, one 
of the study collaborators. Dr. Guo will use the aggregated information to assist 
with manuscript writing and review. 
 
 
8.0 
Adverse Events and Reporting  
8.1 
Definitions 
Adverse Event:  Any symptom, illness or experience that develops or 
worsens in severity and/or frequency during the course of the study (i.e. 
any change from baseline.  Intercurrent illnesses or injuries should be 

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regarded as adverse events.  Abnormal results of diagnostic procedures 
are considered to be adverse events if the abnormality results in study 
withdrawal, is associated with clinical signs or symptoms, leads to 
treatment or to further diagnostic tests, or is considered by the investigator 
to be of clinical significance.  
8.2 
Eliciting Adverse Event Information 
Adverse events will be elicited post surgery, after the patient has been 
extubated. All adverse events that are directly observed and all adverse 
events that are spontaneously reported by the patient are to be 
documented by the investigator. 
8.3 
Grading/Rating Scale 
All adverse events reported during the study will be evaluated and graded 
on a scale of 1-4.  The graded toxicity scale used in this study is the CTC 
version 4.0 for toxicity and Adverse Event reporting. A copy of the CTC 
version 4.0 can be downloaded from the CTEP home page  
(http://ctep.info.nih.gov). 
For adverse events not covered by the CTC, the following definitions will 
be used: 
 
 
Grade 
 
Rating 
 
Description 
 
1 
 
Mild 
 
Adverse event is transient and 
easily tolerated by the patient; 
asymptomatic 
 
2 
 
Moderate 
 
Adverse event causes the patient 
discomfort and interrupts the 
patients usual activities; 
symptomatic but does not interfere 
with function 
 
3 
 
Severe 
 
Adverse event causes considerable 
interference with the patients usual 
activities 
 
4 
 
Life-threatening 
 
Adverse event is incapacitating or 
life-threatening 
 
 
 
8.4 
Reporting of Adverse Events 
All adverse events relating to the placement of the DLT or VDLT during 
the study period will be reported. Potential adverse events include tube 
dislodgement or ineffective ventilation. 
8.4.1 Reporting of Serious and/or Unexpected Events 
 

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 All events occurring during the conduct of a protocol and meeting the 
definition of a SAE must by reported to the IRB in accordance with 
the timeframes and procedures outlined in  “University of Texas M. 
D. Anderson Cancer Center Institutional Review Board Policy ”. 
SAEs must be reported to the IRB and the Sponsor (Safety Project 
Manager) regardless of attribution.  
 All life-threatening or fatal events occurring during the study 
period will have a written report faxed within 24 hours (next working 
day) of knowledge of the event to the Safety Project Manager in the 
Office of Research Education and Regulatory Management 
(ORE&RM) (fax 713-563-5468). The sponsor representative should 
be notified by phone at 713-563-0379 to confirm receipt of the fax.  
 The MDACC Internal Adverse Event Reporting Form will be used for 
reporting to the IRB and the Sponsor (Safety Project Manager 
ORE&RM).  
 It is the responsibility of the PI and the research teams to ensure 
serious adverse events are reported according to the Code of 
Federal Regulations, Good Clinical Practices, the protocol 
guidelines, the sponsor’s guidelines, and Institutional Review 
Board policy. 
 One of the following individuals should be contacted if a patient on 
this trial is known or suspected to have experienced an adverse 
event: 
Jagtar Singh Heir, D.O. phone: 713-792-6911 
 At the time of the initial report the following information should be 
provided if possible: protocol number, study site, patient number, 
study phase during which the event occurred, description of the 
event, date of onset and current status, start date of treatment, 
whether treatment has been discontinued, reason why the event is 
classified as serious, and the investigator’s current assessment of 
the relationship between the event and study treatment.   
8.5 
In Case of Death 
Where feasible and appropriate, an autopsy will be requested on patients 
who die while on study  
 
 
 
9.0  
Data Confidentiality Plan  
All patient-reported outcomes, laboratory and clinical data gathered in this 
protocol will be stored in a password-protected database. All patient information 
will be handled using anonymous identifiers. Linkage to patient identity is only 
possible after accessing a password-protected database. Access to the database 
is only available to individuals directly involved in the study.  
 

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Information gathered for this study will not be reused or disclosed to any other 
person or entity, or for other research. Once the research has been completed, 
identifiers will be retained for as long as is required by law and by institutional 
regulations, and at that point will be destroyed. 

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10.0 Appendix 
 
Appendix 1: Grading system for quality of view provided by VDLT 
Good:  defined as right mainstem bronchus clearly visualized, hint of bronchial cuff seen 
in left mainstem bronchus (slight blue seen) 
Adequate: defined as proper positioning of endobronchial cuff noted, however right 
mainstem bronchus not visualized well/partially 
Poor: defined as unable to recognize anatomy, necessitating FOB to verify confirmation 
of placement  
 
 
Appendix 2:  Potential problems encountered inserting VLDT or DLT 
Difficulties including ruptured cuff, not able to pass vocal cords, not able to occlude 
bronchus for lung isolation  
 
 
Appendix 3: Close up image of embedded camera within VDLT 
 
 
 
 
 
 
 
 
 
 
 

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Appendix 4: DLT image 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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11.0 References 
 
1. Carlens E: A new flexible double-lumen catheter for bronchospirometry. 
a. J Thorac Surg 18:742. 1949. 
2. Robertshaw FL: Low resistance double-lumen endobronchial tubes. British 
Journal of Anaesthesia 1962; 34: 576-9. 
3. Klein U, KarzaiW, BloosF, etal: Role of fiberoptic bronchoscopy in conjunction 
with the use of double-lumen tubes for thoracic anesthesia. Anesthesiology 
88:346-350,1998 
4. Alliaume B, Coddens J, DeloofT: Role of auscultation in positioning of double-
lumen endobronchial tubes. Can J Anaesth 39:687-90. 1992 
5. Lewis JW, Serwin JP, Gabriel FS, etal: The utility of double-lumen tube for one-
lung ventilation in a variety of noncardiac thoracic surgical procedures. J 
Cardiothor Vase Anes 5:705-10, 1992 
6. Campos JH, HallamEA, VanNattaT, etal: 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. Anesthesiology104:261-266,2006 
7. Heir JS, Purugganan R, Jackson TA, etal: A retrospective evaluation of the use 
of video-capable double-lumen endotracheal tubes in thoracic surgery. J 
Cardiothorac Vasc Anesth. 2014 Aug; 28(4):882-4.