A comparison of the I-Gel supraglottic device with endotracheal intubation for bronchoscopic lung volume reduction coil treatment

Study objective: To compare the use of the I-gel airway with orotracheal intubation (OTI) for bronchoscopic lung volume reduction (BLVR) coil treatment in patients with severe chronic obstructive pulmonary disease (COPD) with heterogeneous emphysema, since it has been proved that supraglottic airways have lower incidence of postoperative respiratory complaints compared to OTI.

Design: A comparative, prospective observational study was designed to assess the use of the I-gel airway compared with the OTI.

Setting: Bronchoscopy room at the University Hospital Fundación Jimenez Diaz, Madrid. Tertiary care center.

Patients: Thirty-three procedures were carried out in 22 patients diagnosed with COPD with severe heterogeneous emphysema undergoing BLVR coil treatment under general anaesthesia.

Intervention: Seventeen procedures were carried out with I-gel and 16 with endotracheal tube. Airway device choice was left to the attendant anesthesiologist.

Measurements: Tidal volume, peak pressure, and the presence of gas leaks were compared. Adverse events during the procedure and within the first 3 hours later were also recorded.

Main results: Ventilation parameters obtained showed no significant differences. Mean tidal volume was 466.6 ± 28.2 mL and 478.7 ± 34.0 mL (P > .05), mean peak pressure was 17.9 ± 2.5 cmH2O and 19.4 ± 2.4 cmH2O (P > .05) and mean gas leaks was 71 ± 17.6 mL and 79 ± 15.5 mL (P > .05) for I-gel group (IgelG) and endotracheal tube group respectively. No serious complications were reported. One case of pneumothorax was reported in the endotracheal tube group, which was resolved with a chest drainage tube without further complications.

Conclusion: The I-gel airway ensures appropriate ventilation and makes the use of the flexible fiberoptic bronchoscope quite easy. Therefore, we consider that the I-gel device is an effective and safe alternative to classical OTI for airway management in COPD patients with severe heterogeneous emphysema undergoing BLVR coil treatment.