Movements of the double-lumen endotracheal tube due to lateral position with head rotation and tube fixation: a Thiel-embalmed cadaver study

Maruyama, Daisuke; Chaki, Tomohiro; Omote, Masahito; Hirata, Naoyuki; Yamauchi, M.; Yamakage, Michiaki

doi:10.1007/s00276-014-1411-6

Cited by 15 publications

(17 citation statements)

References 24 publications

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“…Although the amounts of movement of DLTs in previous studies [ 1 , 8 – 10 ] as well as those in our study were slightly different from each other, the predominant direction of the displacement was upward. In other words, the tip of the bronchial lumen of the DLT is likely to be pulled out from the left mainstem bronchus to the trachea during positional change.…”

Section: Discussioncontrasting

confidence: 84%

“…However, an additional mechanism seems to be involved in shifting of the tube, because DLT displacement occurred even in a neutral position of the head and neck in a cadaver model. [ 10 ] Desiderio et al [ 1 ] mentioned that the dynamics of downward movement of the carina with lateral positioning are known to be related to gravity. Further, a flexed lateral decubitus position may often be required to increase the distance between the costal margins during thoracotomy or to improve exposure of the operative field, [ 11 ] and such additional changes in patient position might be responsible for the dynamics of the surrounding organs, including the diaphragm and intra-abdominal organs.…”

Section: Discussionmentioning

confidence: 99%

“…A recent study using cadaver models in which the left mainstem bronchus was directly fixed to the tip of the bronchial lumen of the intubated DLT with forceps showed that the depth of the DLT measured at the right corner of the mouth increased by approximately 0.5 cm after the positional change from supine to both the RLD and LLD. [ 10 ] As the result of a cadaver study, the DLT would be moved by about 0.5 cm upward during lateral positioning regardless of direction if the tube was fixed at the mouth. Considering the size of the bronchial cuff of the DLT (about 1 cm) and the range of correct placement of this cuff within the left mainstem bronchus just below the carina, even such modest movement of a DLT (0.5–1.0 cm) should be avoided to achieve one-lung ventilation successfully.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of a tube-holder (Rescuefix) versus tape-tying for minimizing double-lumen tube displacement during lateral positioning in thoracic surgery

et al. 2016

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Background:Double-lumen endotracheal tubes (DLTs) are often displaced during change from the supine to the lateral decubitus position. The aim of this study was to determine whether Rescuefix, a recently developed tube-holder device, is more effective than the traditional tape-tying method for tube security during lateral positioning.Methods:Patients were randomly assigned to a Rescuefix (R) group (n = 22) or a tape (T) group (n = 22). After intubation with a left-sided DLT and adjustment of the appropriate DLT position using a fiberoptic bronchoscope, the DLT was fixed firmly at the side of the mouth by either Rescuefix or Durapore tape. “Tracheal depth” (from the tracheal carina to the elbow connector of the DLT) and “bronchial depth” (from the left bronchial carina to the elbow connector of the DLT) were measured in the supine position using the fiberoptic bronchoscope. After positional change, tracheal and bronchial depths were measured as described above. As the primary endpoint, displacement of the DLT during positional change was evaluated by obtaining the difference in depths measured when the patient was in the supine and lateral decubitus positions. In addition, after lateral positioning of the patient, any requirement for repositioning the DLT was recorded.Results:After lateral positioning, there were no significant differences in changes in tracheal and bronchial depths between the groups (tracheal depth 6.1 ± 4.4 mm [R group] and 9.1 ± 5.6 mm [T group], P = 0.058; bronchial depth 6.5 ± 4.4 mm [R group], and 8.5 ± 4.6 mm [T group], P = 0.132). Although the amount of change in tracheal and bronchial depths was not different between the groups, the need to reposition the DLT was significantly lower in the R group than in the T group (32% vs 68%, P = 0.016).Conclusion:This study demonstrated that use of Rescuefix did not reduce the amount of DLT displacement, but it did significantly lower the incidence of DLT repositioning compared with the tape-tying method. Therefore, Rescuefix appears to be an effective alternative to minimizing DLT displacement during lateral positioning in thoracic surgery.Trial registration:http://cris.nih.go.kr identifier: KCT0001949.

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Section: Discussioncontrasting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Comparison of a tube-holder (Rescuefix) versus tape-tying for minimizing double-lumen tube displacement during lateral positioning in thoracic surgery

et al. 2016

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“…The tissue quality, elasticity and handling of THCs are satisfactory, and they have been previously used for teaching and urological skills training (12). The efficacy and role of training using THCs were also reported in other departments (12)(13)(14)(15)(16)(17). Furthermore, the validity and reliability of THCs have also been reported in transperitoneal laparoscopic nephrectomy training (18), as well as in various advanced laparoscopic training courses for colon, hernia and bariatric surgery (10).…”

Section: Discussionmentioning

confidence: 90%

Assessment of laparoscopic training for gynecological malignancies using Thiel‑embalmed human cadavers

et al. 2018

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The introduction of laparoscopic surgery has also been beneficial for patients with gynecological malignancies. In this respect, surgeons should receive related training in the context of human resource development. Hands-on training was introduced using Thiel-embalmed human cadavers (THCs) in 2014. To determine the usefulness of THCs, they were evaluated in terms of tissue color, consistency and operative tactility, among others, compared with in vivo laparoscopic training for gynecological malignancies. Hands-on training sessions using THCs were held for a total of 11 times at Ehime University Graduate School of Medicine between March 2014 and October 2017. Training on THCs included advanced laparoscopic procedures for radical hysterectomy type III. At the end of each training session, data were collected using a standardized, anonymous questionnaire termed the Likert scale. THCs ensured flexibility and plasticity of tissues and organs; therefore, the working space was similar to that in the living body under pneumoperitoneum. After analyzing the quality and consistency of tissue and organ color compared with in vivo conditions, most of the participants agreed or strongly agreed regarding the uterus, adnexa and ureter, but not regarding the large blood vessels. The highest scores were observed in the authenticity of the anatomical condition of each organ. Most participants strongly agreed that training using THCs would help improve their laparoscopic skills with a high level of satisfaction. Furthermore, most participants reported that they would recommend this training to other obstetrician-gynecologists. Laparoscopic training for gynecological malignancies using THCs was comparable to the in vivo conditions in terms of surgical view and operative tactility. Therefore, THCs may be an excellent training tool for improving laparoscopic surgical skills for gynecological malignancies.

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“…This means that several factors, such as cervical extension and flexion, DLT size, tracheal deviation, lung collapse during differential ventilation, carinal displacement, and arcuation, may cause DLT displacement when the patient is moved from the supine to lateral position. Both neck extension and flexion cause movement of the DLT [17][18][19][20] . In our study, the VBS was measured under FOB and with a McGRATH MAC ® video laryngoscope with the patient in the supine position and neck extended over a pillow after intubation.…”

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

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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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Movements of the double-lumen endotracheal tube due to lateral position with head rotation and tube fixation: a Thiel-embalmed cadaver study

Abstract: We recommend that the depth of DLT insertion should be advanced by approximately 0.5 cm from the best position, before changing from the supine to lateral position.

Cited by 15 publications

References 24 publications

Comparison of a tube-holder (Rescuefix) versus tape-tying for minimizing double-lumen tube displacement during lateral positioning in thoracic surgery

Comparison of a tube-holder (Rescuefix) versus tape-tying for minimizing double-lumen tube displacement during lateral positioning in thoracic surgery

Assessment of laparoscopic training for gynecological malignancies using Thiel‑embalmed human cadavers

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

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