New landmarks improve the positioning of the left Broncho-Cath™ double-lumen tube-comparison with the classic technique

Abstract

Using this new technique, the LM-DLT is inserted deeper in the left mainstem bronchus. This new landmark augments the range of movement that can be tolerated without requiring repositioning of the LM-DLT. This NT to position and to assess LM-DLT, by transparency across the wall of the tube with FOB, is better adapted to the LM-DLT and its recent modifications.

Double-lumen tube placement with the patient in the supine position without a headrest minimizes displacement during lateral positioning

“…Furthermore, in order to make DLT displacement less risky, we recommend positioning the proximal margin of the DLT bronchial cuff 5-10 mm deeper than the carinal level before lateral positioning. [5][6][7] During direct laryngoscopy in the sniffing position, the patient's head is usually elevated by supporting the occiput on a headrest about 10 cm high. 12 In our study, the 9 cm high headrest was used because it provided better laryngoscopic views than 3 cm or 6 cm high headrests.…”

“…[2][3][4][5] When patients are turned to the lateral position, outward displacement of DLTs predominates. [5][6][7] Therefore, extension of the head and neck was considered customary during lateral positioning. Tracheal intubation is most likely performed under direct laryngoscopy with the patient in a supine position on a headrest.…”

Correct positioning of double-lumen tubes

“…In their protocol, Dr. Seo et al used the BronchoCath L-DLT (Mallinckrodt Inc, St-Louis, MO, USA), and they established their end point as ''the bronchial cuff was placed just below the carina without herniation''. One of the authors of this article (J.B.) 5 proposed an alternative landmark to position the Broncho-Cath L-DLT. The design of the Broncho-Cath was modified in 1994 to include a black radiopaque line located proximal to the bronchial cuff.…”

Use of a neck brace minimizes double-lumen tube displacement during patient positioning

“…2 After the lateral positioning of patients with the Broncho-Cath® DLT, malposition requiring repositioning or resulting in movement longer than 5 mm has been observed in 46.5% and 53% of cases. 1,3 After patient positioning, displacement of the DLT was observed in 52.5%. 4 In our study, the clinically significant displacement of the DLT in the control group was 48%, which is comparable to the incidence reported previously.…”

“…The main cause of the DLT displacement during lateral positioning appears to be related to movement of the head and neck. Tae-Gyoon Yoon MD,* Hye-Won Chang MD, † Ho-Geol Ryu MD,* Tae-Dong Kwon MD,* Jae-Hyon Bahk MD* While patients are moved from the supine to the lateral decubitus position, proximal displacement predominates, [1][2][3][4] but distal displacement may also occur. [1][2][3] In a prior thoracotomy case (unpublished observation), whose entire cervical spine was affected by ankylosing spondylitis, however, we observed that the Univent® tube and bronchial blocker (Fuji Systems Corporation, Tokyo, Japan) were not displaced during the lateral positioning.…”