VivaSight: a new era in the evolution of tracheal tubes

•The main purposes of using the VivaSight tubes are continuous visualization of the airway.•It is difficult to agree that VivaSight tube reduces the need or use of flexible bronchoscopy.•In the postoperative period, sore throat or dysphonia may occur as a complication.•Heat injury and burns to the mucosa may take place due to melting after the tube insertion.

Study objectiveTo evaluate the available data describing the use of single and double lumen VivaSight tubes.DesignSystematic review.SettingThe use of VivaSight tubes for elective surgeries including advantages, disadvantages, and possible complications.PatientsSystematic review of randomized controlled trials from databases including Medline, Web of Knowledge, Google Scholar, and Cochrane Central Register of Controlled Trials.InterventionsComparison of VivaSight single and double-lumen tubes with conventional tubes during normal airway and expected difficult airway management. The effectiveness of the devices was also evaluated during 1-lung ventilation for patients undergoing thoracic surgery.MeasurementsIntubation time, success rate, the requirement for fiberoptic bronchoscope, and the rate of complications.Main ResultsFollowing a VivaSight double-lumen tube, a flexible bronchoscope is still needed. It is difficult to agree that VivaSight tube reduces the need or use of a bronchoscope. According to the current literature, it is unclear if there is any advantage of the VivaSight compared with using flexible bronchoscopy to direct a blocker into the correct lung. The cost may be another issue. Studies comparing VivaSight tubes with standard double lumen tubes reported faster tracheal intubation rate and higher success rate at first attempt for VivaSight. However, VivaSight tubes may cause soft tissue trauma such as bleeding, hematoma, edema, and erythema. Sore throat and dysphonia are other reported complications. Due to the outer thickness, smaller-sized double-lumen tube may be necessary. It has been reported to have the disadvantages, such as melting due to the heat of light source before insertion and sudden shutdown without warning.ConclusionsProblems such as overheating and melting on the distal end of the tube due to the light source and potential breakdowns of the cable should be solved by the manufacturer. This will probably require a redesign and necessitate further studies.