Measurements of the Length and Diameter of Main Bronchi on Three-Dimensional Images in Asian Adult Patients in Comparison With the Height of Patients

Kim, Deokkyu; Son, Ji-Seon; Ko, Seonghoon; Jeong, Woojoo; Lim, Hyungsun

doi:10.1053/j.jvca.2013.05.029

Cited by 27 publications

(23 citation statements)

References 14 publications

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“…Finally, the number of male patients of a short stature is much lower than that of females, meaning here that any gender difference with reference to airway dimension could not be analyzed. Previous studies reported no significant differences of airway dimensions between genders [6,21]. Although the earlier studies showed larger airway dimensions in male groups, they concluded that this difference was not due to gender but was instead caused by the greater heights of those in the male groups.…”

Section: Discussionmentioning

confidence: 82%

“…When OLV is not properly achieved, it can affect not only the surgical outcome but also patient safety. The size and depth of the insertion of the DLT are important factors for successful OLV [2][3][4][5][6]. Many previous studies have shown that the patient's height is correlated with the size and depth of the insertion of the DLT and that the height can be used to determine these values [5,[7][8][9].…”

Section: Introductionmentioning

confidence: 99%

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Airway dimensions and margin of safety with the left-sided double-lumen tube in patients of a short stature

Lee¹,

Lee²,

Choi³

et al. 2015

Anesth Pain Med

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This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Background:The size and depth of the double-lumen tube (DLT) are important for one-lung ventilation (OLV). In patients of a short stature, it is difficult to perform OLV successfully. We designed this study to evaluate the dimensions and margin of safety of the left main bronchi in patients of a short stature for appropriate OLV. Methods: Chest computed tomography (CT) scans of 241 patients (22 male, 219 female) of a short stature (height below 155 cm) were analyzed retrospectively. The diameters of the trachea (DT), the right and left main bronchi (DR and DL), and the lengths of the right and left main bronchi (LR and LL) were measured at the coronal section of the chest CT scans using a picture archiving communication system program. Results: There were no significant correlations between the heights and lengths of the right and left main bronchi. In addition, the ages and weights of the patients showed no significant correlations with the airway dimensions. The lengths of the bronchial lumen of the left-sided Mallinckrodt DLT show variations of 3 to 5.5 mm with tubes of identical sizes. The margin of safety is 13.8 ± 4.1 mm assuming that appropriately sized DLTs are inserted. Conclusions: For successful and safe OLV in patients of a short stature, anesthesiologists should consider the length of the main bronchus and the actual length of the bronchial lumen of the DLT.

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Section: Discussionmentioning

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Airway dimensions and margin of safety with the left-sided double-lumen tube in patients of a short stature

Lee¹,

Lee²,

Choi³

et al. 2015

Anesth Pain Med

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show abstract

“…e parts of the airway most relevant for the tube size selection are the larynx and the main bronchi, with the trachea presenting less of a problem with regard to tube diameters. [2,11,14,15,[17][18][19]] e more distal parts of the patients' airways quickly become anatomically narrower and shorter, making the corresponding (more distal; patient end) portions of the respective DLT critical for proper airway management [1]. As such, the distance from tracheal to bronchial cuff, the length of the bronchial cuff, and the tube diameter in the bronchial segment can be regarded as particularly important [18].…”

Section: Discussionmentioning

confidence: 99%

“…First, reference tables are used that indicate the DLT size based on a patient's height and gender [2,9,10]. Second, there are methods incorporating actual patient information from radiological imaging as tracheal width or the size of the left main-stem bronchus [2,[11][12][13][14][15][16]. e latter has become more relevant in recent years, as the majority of patients planned for thoracic surgery with one-lung ventilation have usually undergone preoperative computed tomography (CT) imaging of their lungs and trachea-bronchial tree.…”

Section: Introductionmentioning

confidence: 99%

Dimensional Variations of Left-Sided Double-Lumen Endobronchial Tubes

Hegland

Schnitzler

Ellensohn

et al. 2019

Anesthesiology Research and Practice

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Background. Tube size selection is critical in ventilating patients’ lungs using double-lumen endobronchial tubes (DLTs). Little information about relevant parameters is readily available from manufacturers. The aim of this study is to provide reference data for relevant dimensions of conventionally available DLTs. Methods. In this study in a benchmark in vitro setup, several dimensional parameters of four sizes of left-sided double-lumen endobronchial tubes from six different manufacturers were assessed, such as distances and diameters of tube shaft, cuff lengths, and diameters as well the angle at the tip. Results. Endobronchial tubes of ostensibly the same size revealed wide variation in measured parameters between brands from different manufacturers. In some parameters, there was an overlap between different sizes from the same manufacturer, i.e., diameters and distances did not increase with increasing nominal endobronchial tube size. The information about dimensions of endobronchial tubes provided by manufacturers’ leaflets is insufficient. Conclusions. Endobronchial tube size selection carries unnecessary uncertainty because clinically relevant parameters are unknown and vary considerably between different manufacturers.

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“…[6] Moreover, left DLTs <35-Fr (9.6 mm, Broncho-Cath™) in size were needed in 27 of 48 women with heights of 152–160 cm. [8] According to Miller's Anaesthesia, a reputed textbook, the bronchial diameter should be examined and a 32-Fr DLT should be considered for short-statured female patients (<152 cm); the DLT should be able to pass the glottis without resistance. [9] Difficulties were reported in placing 35-Fr DLTs in three American female patients with LMBDs ≤10 mm,[3] in inserting 32-Fr DLTs in one of seven Asian female patients with LMBDs <10 mm and in inserting 35-Fr DLTs in five of nine Asian female patients with LMBDs ≥10 mm but <11 mm.…”

Section: Discussionmentioning

confidence: 99%

Difficulty in inserting left double-lumen endobronchial tubes at the cricoid level in small-statured women: A retrospective study

Sato

Kayashima

2017

Indian J Anaesth

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Background and Aims:Left double-lumen endobronchial tube (DLT) sizes are selected using tracheal diameters and left mainstem bronchial diameters (LMBDs) determined from chest radiographs or computed tomography (CT) scans. In Western women, 35-Fr or 37-Fr DLTs are often selected. However, difficulties can be encountered when inserting 32-Fr or 35-Fr DLTs in Japanese women. We investigated success rates for 32-Fr or 35-Fr DLT insertion in Japanese women and determined the causes of unsuccessful DLT insertion.Methods:We searched anaesthesia records of Japanese women aged ≥20 years who underwent thoracic surgery with 32-Fr or 35-Fr DLTs between April 2010 and March 2015 in our hospital. In the successful group (SG), patients were intubated using the initially selected DLTs. By contrast, in the unsuccessful group (UG), the DLT size had to be changed. The Mann–Whitney U-test and Fisher's exact test were used to compare groups.Results:The SG included 149 (96.1%) of 155 cases of 32-Fr DLT use and 119 (95.2%) of 125 cases of 35-Fr DLT use. Patient height was significantly lower in the UG than in the SG for the 35-Fr DLT (P = 0.0036). In seven of 12 UG patients (three for 32-Fr and four for 35-Fr), the transverse diameters of cricoid cartilages were smaller than the DLTs' tracheal diameters, thereby preventing passage through the cricoid cartilages.Conclusion:Along with LMBDs, transverse diameters of cricoid cartilages based on CT scans or ultrasonogram findings may help in selecting the appropriate left DLT size.

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Measurements of the Length and Diameter of Main Bronchi on Three-Dimensional Images in Asian Adult Patients in Comparison With the Height of Patients

Cited by 27 publications

References 14 publications

Airway dimensions and margin of safety with the left-sided double-lumen tube in patients of a short stature

Airway dimensions and margin of safety with the left-sided double-lumen tube in patients of a short stature

Dimensional Variations of Left-Sided Double-Lumen Endobronchial Tubes

Difficulty in inserting left double-lumen endobronchial tubes at the cricoid level in small-statured women: A retrospective study

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