Double-lumen tube position should be confirmed by fiberoptic bronchoscopy

Cohen, Edmond

doi:10.1097/00001503-200402000-00002

Cited by 60 publications

(54 citation statements)

References 16 publications

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“…Immediate verification of tube position using fibreoptic bronchoscopy is required in such cases. 8 Correct positioning of DLTs must be confirmed using flexible bronchoscopy. 8 Handling the flexible bronchoscope requires a high level of experience as well as the infrastructure for cleaning and maintaining these fragile instruments.…”

Section: Discussionmentioning

confidence: 99%

“…8 Correct positioning of DLTs must be confirmed using flexible bronchoscopy. 8 Handling the flexible bronchoscope requires a high level of experience as well as the infrastructure for cleaning and maintaining these fragile instruments. 10,11 Continuous visualisation potentially provides earlier identification and correction of endobronchial displacement.…”

Section: Discussionmentioning

confidence: 99%

“…11,12 Although insertion without use of flexible bronchoscopy was often successful, it failed about 15% of the time, clearly supporting the current standard of confirming DLT position with flexible bronchoscopy. 6,8,[13][14][15][16] In contrast, flexible bronchoscopy was unnecessary with the VivaSight DLT because a camera is incorporated into the tube.…”

Section: Discussionmentioning

confidence: 99%

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Intubation with VivaSight or conventional left-sided double-lumen tubes: a randomized trial

Schuepbach

Grande

Camen³

et al. 2015

Can J Anesth/J Can Anesth

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Introduction Double-lumen endotracheal tubes (DLTs), which are commonly used for single-lung ventilation during surgery, are difficult to insert. In addition, they often move during surgical lung manipulation which can cause lifethreatening complications. Flexible bronchoscopy is used routinely to establish and confirm proper DLT placement. The newly designed VivaSight DLT has an integrated camera, allowing continuous visualization of its position in the trachea. We hypothesized that the time to intubation using the VivaSight DLT would be faster than with a conventional DLT. Methods We enrolled 40 adults scheduled for thoracic surgery. Patients were randomized to conventional DLT (n = 20) or VivaSight DLT (n = 20). Time to intubation was our primary outcome. Secondary outcomes were insertion success without flexible bronchoscopy, frequency of tube displacement, ease of insertion, quality of lung collapse, postoperative complaints, and airway injuries. Results Time [mean (SD)] to successful intubation was significantly faster with the VivaSight DLT [63 (58) sec] compared with the conventional DLT [97 (84) sec; P = 0.03]. The VivaSight DLTs were correctly inserted during all attempts. When malpositioning of the VivaSight DLT occurred, it was easily remedied, even in the lateral position. The devices were comparable with respect to postoperative coughing, hoarseness, and sore throat. Airway injuries tended to be more common with the VivaSight DLT, although this study was underpowered for airway injuries.Author contributions Rolf Schuepbach and Bastian Grande made substantial contributions to study conception and design, acquisition of data, and manuscript writing. Giovanni Camen and Alexander R. Schmidt made substantial contributions to acquisition and interpretation of data and helped draft the manuscript. Henrik Fischer made substantial contributions to analysis and interpretation of data and revised the article for important intellectual content. Daniel I. Sessler made substantial contributions to study conception and design, analysis and interpretation of data, and drafting the manuscript. Burkhardt Seifert made substantial contributions to analysis and interpretation of data and revised the manuscript for intellectual content. Donat R. Spahn made substantial contributions to study conception and design and assisted with manuscript revision. Kurt Ruetzler made substantial contributions to study conception and design; acquisition of data analysis and interpretation; and was responsible for drafting the manuscript. Single-lung ventilation is required in several clinical situations and for various surgical procedures. Perhaps the most frequent indication is thoracic surgery during

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Intubation with VivaSight or conventional left-sided double-lumen tubes: a randomized trial

Schuepbach

Grande

Camen³

et al. 2015

Can J Anesth/J Can Anesth

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“…(7) After insertion of the left tube without a hook, bronchoscopy is recommended to check the position of the tube. (8)(9)(10)(11) There is no consensus on the best technique for lung isolation for thoracic surgery. (12) The most commonly used are left sided DLTs which are placed into the left main bronchus and the right or left lung can be isolated.…”

Section: Introductionmentioning

confidence: 99%

One lung ventilation: double-lumen tube with vs. without carinal hook

Potočnik¹,

Andjelković²,

Markovič-Božič³

2018

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Background. One lung ventilation (OLV) has become a standard procedure for the vast majority of interventions in pulmonary surgery. The most commonly used are left sided double-lumen tubes (DLTs) which are placed into the left main bronchus and the right or left lung can be isolated. The aim of our study was to compare DLTs with and without a hook. Materials and methods. Fifty-four patients undergoing lung resection were included in the randomized, controlled, single-blinded study. Recruited patients were randomly allocated to each group (hook/without hook). Demographic data, procedural data, type of tube used, and difficult intubation criteria were recorded. Complications, according to intubation and position of the tube, were also recorded. After the operation, we aske patients about a sore throat, hoarseness, haemoptysis and their satisfaction with the procedure. Results. Baseline characteristics were well balanced between groups. Time to place DLT was shorter in the group without a hook (47.7±45.5 vs 15.8±15.1s; P=0.01). The incidence of adequate positioning at the first attempt was higher in the group with a hook and the repositioning rate was higher in the group without a hook (22.22 vs 59.25%; P=0.004). Patients in both groups suffered similar incidences of hoarseness, sore throat or postoperative haemoptysis (5/5/1 vs 3/3/0; P = 0.44). Patient satisfaction was higher in the group without a hook (31.85% vs 34.81%;0.03). Conclusion. The study showed the advantage of DLTs without a hook in comparison with DLTs with a hook. In our institution we decided to use DLTs without a hook, with fiberoptic control.

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“…Due to their larger size and rigidity, double lumen tubes are more difficult to insert, and complications are more common than with single lumen tubes. Opinions about the need for regularly checking the position of a double lumen tube by fibre optic bronchoscopy directly after intubation are divided [3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Iatrogenic rupture of the trachea caused by double Lumen tube intubation

2010

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AbstractAcute injuries of the tracheobronchial system are rare and life-threatening situations. Tracheal rupture most commonly occurs after blunt trauma to the chest. It is a rare but most concerning immediate complication of intubation. One-lung ventilation is required in lung surgery. Video assisted thoracoscopic procedures are an absolute indication for one-lung intubation. The double-lumen tube is the mainstay of one lung ventilation. Due to their larger size and rigidity, double lumen tubes are more difficult to insert, and complications are more common than with single lumen tubes. Opinions about the need for checking routinely the position of a double lumen tube by fiber optic bronchoscopy directly after intubation are divided. A 69-year-old woman with epidermoid lung carcinoma was scheduled for video assisted thoracoscopic left upper pulmonary lobectomy under general anaesthesia. The patient was prepared for the operation and itubated with the Carlens double lumen tube as usual. On introducing the camera into the thoracic cavity, the surgeon noted that the lungs were not completely collapsed. During blind adjustment the position of the tube the trachea was ruptured. The right-sided thoracotomy was performed and closed the greater part of the tracheal laceration. Only its upper 1.5-cm segment was surgically inaccessible because of the anatomical situation and thus remained unsutured. The patient received antibiotics, continuous airway humidification, analgesia with piritramide, and chest physiotherapy. She had no complications. In the literature, opinions about checking routinely the position of a double lumen tube by fiber optic bronchoscopy are divided.. Possibly, the very serious complication encountered in our patient could have been avoided, had the tube position been checked by bronchoscopy. The treatment strategy for post-intubation tracheal rupture depends on the size and location of the rupture, its clinical presentation, and the overall condition of the patient). Early surgical repair is the treatment of choice for most patients when a transmural tear with a length exceeding 2 cm. In our the combination of surgical and conservative treatment was performed. The uppermost part of the tear could not be sutured because of the anatomical situation, and so about 1.5 cm of the trachea remained open. The case is interesting from many perspectives. It shows that intubation with a Carlens tube is a potentially hazardous procedure, which should be performed only by experienced anaesthesiologists. Furthermore, our case report underscores the importance of checking routinely the position of a double lumen tube by fiber optic bronchoscopy. It provides evidence that minor tracheal lacerations can be successfully managed by conservative measures.

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Double-lumen tube position should be confirmed by fiberoptic bronchoscopy

Abstract: Advances in technology and improved quality of the endoscopes image make the technique easy to use with a relatively simple learning curve. In fact, fiberoptic workshops, thoracic workshops and difficult airway workshops are offered in nearly all important anesthesia meetings.

Cited by 60 publications

References 16 publications

Intubation with VivaSight or conventional left-sided double-lumen tubes: a randomized trial

Intubation with VivaSight or conventional left-sided double-lumen tubes: a randomized trial

One lung ventilation: double-lumen tube with vs. without carinal hook

Iatrogenic rupture of the trachea caused by double Lumen tube intubation

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