Depth of Placement of Left Double-Lumen Endobronchial Tubes

Brodsky, Jay B.; Benumof, Jonathan L.; Ehrenwerth, Jan; Ozaki, George T.

doi:10.1213/00000539-199111000-00010

Cited by 98 publications

(49 citation statements)

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“…If the diameter of the left mainstem bronchus was 12, 13, or greater than 14 mm, a DLT size 35-, 37/39-, and 41-French, respectively, was chosen. 12 The estimated depth of insertion was derived from the following formula 13 : depth DLT (cm) = 12 + length patient (cm) × 10 -1 . The styletted DLT without a carinal hook (Broncho-cath; Mallinckrodt, Athlone, Ireland) was introduced into the glottis via direct laryngoscopy.…”

Section: A Comparison Between Dlt and Ezbmentioning

confidence: 99%

Efficiency, Efficacy, and Safety of EZ-Blocker Compared with Left-sided Double-lumen Tube for One-lung Ventilation

Mourisse

Liesveld

Verhagen³

et al. 2013

Anesthesiology

122

119

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Background: Double-lumen tubes (DLTs) or bronchial blockers are commonly used for one-lung ventilation. DLTs are sometimes difficult or even impossible to introduce, and the incidence of postoperative hoarseness and airway injuries is higher. Bronchial blockers are more difficult to position and need more frequent intraoperative repositioning. The design of a Y-shaped bronchial blocker, the EZ-Blocker (Teleflex Life Sciences Ltd., Athlone, Ireland) (EZB), combines some advantages of both techniques. The objective of this study was to assess whether EZB performs clinically better than left-sided DLTs (Broncho-cath; Mallinckrodt, Athlone, Ireland) without causing more injury. Primary outcome was the frequency of initial malpositions. Methods: Eligible patients were adults scheduled for surgery requiring one-lung ventilation who met criteria for placement of both devices. In this parallel trial, 100 consecutive and blinded patients were assigned randomly using a computer-generated list to two groups. The incidence of malposition and ease and time of placement were recorded. Blinded assessors investigated quality of lung deflation, postoperative complaints, and damage to the airway.Results: Placement of a DLT was unsuccessful twice. The incidence of initial malposition was high and comparable between EZBs (37 of 50) and DLTs (42 of 49) (P = 0.212). Placing single-lumen tubes and EZBs took more time but was rated easier. Quality of lung deflation was comparable. Fewer patients in the EZB group complained of sore throat at day 1. There was a higher incidence of tracheal hematoma and redness and bronchial hematoma in the DLT group. Conclusions:The EZB is an efficient and effective device for one-lung ventilation and causes less injury and sore throat than a DLT.

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Section: A Comparison Between Dlt and Ezbmentioning

confidence: 99%

Efficiency, Efficacy, and Safety of EZ-Blocker Compared with Left-sided Double-lumen Tube for One-lung Ventilation

Mourisse

Liesveld

Verhagen³

et al. 2013

Anesthesiology

122

119

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show abstract

“…We also measured VBL by FOB and with a McGRATH . Further, Brodsky et al 9) demonstrated that a pillow causes extension of the neck and that the depth of insertion is easy to change with a pillow. These studies showed that the use of a pillow and either cervical extension or cervical flexion are strongly associated with the difference in ADP between the supine and lateral position.…”

Section: Discussionmentioning

confidence: 99%

“…Height-based ADP was calculated as height (cm) × 0.11 + 10.5 9) . The resulting height-based ADP was assumed to equal the distance from the patients' incisors to the DLT tip.…”

Section: Determining the Adpmentioning

confidence: 99%

“…It may also decrease the incidence of serious surgical complications 8) . Conventionally, the ADP is calculated on the basis of the patient's height or on a preoperative chest X-ray (CXR) film 9) . Benumof et al described the most acceptable distal position of a left-sided DLT as the position in which the tip of the left lumen can be seen at the proximal edge of the left upper lobe bronchial orifice under fiberoptic bronchoscopy (FOB) 10) .…”

Section: Introductionmentioning

confidence: 99%

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Feasibility of MDCT for Predicting Left Double Lumen Endotracheal Tube Displacement during Supine to Lateral Repositioning of Patients

Tanigawa

Masumori

Okuda

et al. 2015

J St. Marianna Univ

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Multidetector-row computed tomography (MDCT) allows visualization and measurement of anatomical structures. Because we seek a reliable method by which we can predict displacement of the double lumen endotracheal tube (DLT) in patients when supine to lateral repositioning is required during surgery, we performed MDCT preoperatively for 84 patients scheduled for elective respiratory surgery with a left DLT. We obtained 3D MDCT reconstruction images of each patient's bronchus and then measured the distance between the vocal cords and the bifurcation of the left upper lobe bronchus. We defined this distance as the MDCT-derived appropriate depth of placement (ADP). We used two other methods to determine ADP: the standard measurement method based on the patient's height and the chest X-ray method based on the distance from the superior border of the sixth cervical vertebra to the tracheal bifurcation. During surgery, we evaluated the actual change in ADP when the patient was moved from the supine to the lateral position. We then compared the actual ADP with the MDCT-derived ADP to assess whether the MDCT-derived ADP predicts DLT displacement during the patient repositioning.We found that during surgery, the DLT had slipped out of position in 31 (44%) patients, had moved too deeply in 6 (7%), and had not changed in 41 (49%). Multiple logistic regression analysis showed that the MDCT-derived ADP was significantly associated with DLT displacement upon patient repositioning (odds ratio, 2.9; 95% CI, 1.5-5.6; p=0.002), whereas standard ADP and chest X-ray-derived ADP were not associated with DLT displacement. We postulate that various factors, such as extension or flexion of the neck and size of the DLT, may contribute the DLT displacement during patient repositioning.We believe, on the basis of our study data, that ADP derived from pre-operative MDCT will be useful for predicting DLT displacement when patients are moved from the supine to lateral position during surgery.

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“…• Arterial hypoxemia is obviously undesirable, but in spite of everything, it might be better to accept PaO2 a little lower than preoperative value, than to undertake measures like inflation of the upper lung, which could present an obstacle for surgical intervention and could prolong it (21,22,42,59,66,67). At the end, it could be concluded that:…”

Section: Discussionmentioning

confidence: 99%

The Effect of One Lung Ventilation on Intrapulmonary Shunt During Different Anesthetic Techniques

Taleska¹,

Trajkovska²

2012

Topics in Thoracic Surgery

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Depth of Placement of Left Double-Lumen Endobronchial Tubes

Cited by 98 publications

References 0 publications

Efficiency, Efficacy, and Safety of EZ-Blocker Compared with Left-sided Double-lumen Tube for One-lung Ventilation

Efficiency, Efficacy, and Safety of EZ-Blocker Compared with Left-sided Double-lumen Tube for One-lung Ventilation

Feasibility of MDCT for Predicting Left Double Lumen Endotracheal Tube Displacement during Supine to Lateral Repositioning of Patients

The Effect of One Lung Ventilation on Intrapulmonary Shunt During Different Anesthetic Techniques

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