Left double-lumen tubes: clinical experience with 1,170 patients

Brodsky, Jay B.; Lemmens, Harry J. M.

doi:10.1016/s1053-0770(03)00046-6

Cited by 187 publications

(111 citation statements)

References 98 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The wall of the distal bronchus blocks the DLT tip; we cannot insert it deeply. Both Klein et al 13) and Brodsky et al 14) reported the incidence of displacement with patient repositioning, but neither group calculated the amount of displacement. Although Yoon et al 15) reported the amount of displacement, they determined this under FOB and did not compare the ADP between the supine and lateral positions.…”

Section: Discussionmentioning

confidence: 99%

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

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

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

View full text Add to dashboard Cite

show abstract

“…Elles sont utilisées depuis plus de 50 ans; la plupart des anesthésiologistes et des chirurgiens les connaissent donc bien et savent bien les utiliser. [2][3][4][5][6] La décision d'avoir recours à une sonde endotrachéale double lumière ou un bloqueur bronchique se fonde sur trois facteurs : la sécurité des patients, l'aise de l'anesthésiologiste avec le dispositif choisi, et la préférence du chirurgien. Malheureusement, dans certaines situations, ces trois facteurs sont irréconciliables.…”

Section: Stratégies D'isolationunclassified

“…They have been used for more than 50 years, and as a result, most anesthesiologists and surgeons are familiar with them and are comfortable with their use. [2][3][4][5][6] The decision whether to use a DL-ETT or BB depends on three factors: patient safety, the anesthesiologist's comfort with the selected device, and the surgeon's preference. Unfortunately, there are sometimes situations where these three factors cannot coincide.…”

mentioning

confidence: 99%

Strategies for lung isolation: to block or not to block?

Cohen

2016

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

In this issue of the Journal, Bussières et al.1 report their findings of a randomized-controlled trial evaluating the use of a bronchial blocker (BB) vs a left-sided double-lumen endotracheal tube (DL-ETT) during video-assisted thoracoscopic surgery (VATS). The focus of their study was on the quality of lung collapse and the time to achieve optimal lung deflation.The authors studied 40 patients requiring one-lung ventilation (OLV) and randomized to receive a BB or a left-sided DL-ETT. The time from opening the pleura until complete lung collapse as well as the quality of lung collapse (graded from 1-3) were evaluated in real time by the surgeons who were blinded to the method used to achieve lung separation. The time to lung collapse and the quality of the collapse were also graded offline by independent observers -i.e., two thoracic surgeons and an anesthesiologist who reviewed video recordings of the VATS procedures. Finally, the operating surgeons were asked to guess which device was used for lung isolation.The findings of the study showed that the time to complete lung collapse in patients having elective VATS was significantly faster with a BB than with a left-sided DL-ETT. The scores of the quality of lung deflation at 5, 10, and 20 min following opening of the pleura were also better in the BB group than in the DL-ETT group, in both real-time and offline assessments. Finally, when the surgeons were asked to guess which method was being used for lung isolation, they were correct only 37% of the time. This outcome would suggest that the two devices could be used interchangeably without the surgeon noticing any differences.As DL-ETTs are considered the ''gold standard'' for lung separation, they are the most widely used devices for performing this procedure. They have been used for more than 50 years, and as a result, most anesthesiologists and surgeons are familiar with them and are comfortable with their use. [2][3][4][5][6] The decision whether to use a DL-ETT or BB depends on three factors: patient safety, the anesthesiologist's comfort with the selected device, and the surgeon's preference. Unfortunately, there are sometimes situations where these three factors cannot coincide. As with many devices, correct use of a BB involves a significant learning curve, and most anesthesiologists are unfamiliar with the device and inexperienced in its use. As a result, a thoracic surgeon who is not accustomed to having a BB used for OLV may be reluctant to accept this new technique.The study by Bussières et al. 1 addresses some of the myths surrounding the use of a BB. Indeed, there may be a bias against its use and an impression amongst surgeons (and some anesthesiologists) that a BB fails to provide optimal lung separation.7 These myths regarding the BB include the view that the quality of lung collapse is inferior to that with the DLT; that it would take more time to achieve adequate lung deflation than with the DL-ETT; and that it takes less time to insert and position a DL-ETT than to perform the same procedure...

show abstract

“…Rates of hypoxemia as low as 1% have been reported. 9 Nevertheless, hypoxemia likely continues to occur in up to 10% of patients and remains a significant clinical concern. 10 Failure of lung isolation is a well-recognized mechanism for intraoperative hypoxemia.…”

Section: Physiology Of Olvmentioning

confidence: 99%

“…On a rapporté des taux d'hypoxémie aussi bas que 1 %. 9 Ceci étant dit, l'hypoxémie survient probablement encore chez près de 10 % des patients et demeure une inquiétude clinique importante. 10 Une mauvaise isolation du poumon est un mécanisme bien connu provoquant l'hypoxémie peropératoire.…”

Section: Au Début De La Vup Et Au Besoinunclassified