Placement of a Double-Lumen Endotracheal Tube

Hao, David; Saddawi-Konefka, Daniel; Low, Sarah; Alfille, Paul H.; Baker, Keith

doi:10.1056/nejmvcm2026684

Cited by 14 publications

(19 citation statements)

References 6 publications

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“…Traumatic laryngitis is a complication associated with DLT placement [ 7 ]. PILE results from trauma to the laryngeal mucosa causing mucosal edema and swelling.…”

Section: Discussionmentioning

confidence: 99%

“…Approximately 54% of the patients who have undergone intubation or tracheostomy have subvocal ulcers, and 93% have mucosal inflammation or edema [ 1 ]. Therefore, the DLT should be of appropriate size and according to the patient’s sex, physique, and imaging data (CT or chest radiography) [ 7 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…Our patient was male with an adequate to small size DLT [ 7 ] and smooth intubation. There were no previously reported risk factors in such cases; however, this patient had previously been treated with chemoradiotherapy (CRT) and larynx edema was noted preoperatively.…”

Section: Discussionmentioning

confidence: 99%

“…Female individuals have anatomically smaller airways than male individuals and, therefore, they are at a higher risk of developing PILE [7,9]. To our knowledge, there are 11 reported cases of PILE after lung surgery using DLT (including ours), in the English and Japanese literature (Table 1) [2][3][4][5][6].…”

Section: Discussionmentioning

confidence: 99%

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Temporary tracheotomy for post-intubation laryngeal edema after lung cancer surgery: a case report

Iijima

Takaoka

Motono

et al. 2023

J Cardiothorac Surg

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Background In the post-intubation period, laryngeal edema is one of the most severe complications, which can cause significant morbidity and even death. Herein, we report a case in which we performed a temporary tracheostomy during surgery because of the risk of postoperative laryngeal edema, successfully avoiding post-intubation laryngeal edema complications. Case presentation A 78-year-old man underwent surgery for left upper lobe lung cancer. He had a history of chemoradiotherapy for laryngeal cancer, bronchial asthma, and chronic obstructive pulmonary disease. He was diagnosed with grade 1 laryngeal edema using computed tomography, and there was a risk of developing post-intubation laryngeal edema. Additionally, there was a decrease in laryngeal and pulmonary functions; therefore, postoperative aspiration pneumonia was judged to be a fatal risk. A temporary tracheostomy was performed during surgery to avoid postoperative intubation laryngeal edema. He was found to have exacerbated laryngeal edema, which is a serious complication of airway stenosis. Conclusions Temporary tracheostomy should be considered to avoid airway stenosis due to post-intubation laryngeal edema in patients with laryngeal edema after radiotherapy.

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“…Traumatic laryngitis is a complication associated with DLT placement [ 7 ]. PILE results from trauma to the laryngeal mucosa causing mucosal edema and swelling.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Temporary tracheotomy for post-intubation laryngeal edema after lung cancer surgery: a case report

Iijima

Takaoka

Motono

et al. 2023

J Cardiothorac Surg

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“…Searching for modalities that reduce the possible risks of cross-infection following the COVID-19 pandemic raised concerns about new tools that can effectively replace FOB. Chest auscultation alone is not reliable for assessing DLT placement as it is subjective and cannot accurately identify DLT misplacement (7,8).…”

Section: Introductionmentioning

confidence: 99%

Role of Lung Ultrasound in Confirmation of Double Lumen Endotracheal Tube Placement for Thoracic Surgeries: A Prospective Diagnostic Accuracy Study

2022

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Background: In thoracic surgeries requiring thoracotomy incisions, correct positioning of the double-lumen endotracheal tube (DLT) is mandatory. After the pandemic of novel COVID-19, using simple, noninvasive technology such as lung ultrasound (LUS) can be important in avoiding the possibility of spreading infectious diseases or contagious infections that can follow using fiberoptic bronchoscopy (FOB). Objectives: We aimed to assess the accuracy of auscultation and LUS in relation to FOB in the assessment of DLT placement and to identify the possibility of using LUS as an alternative to FOB during DLT insertion. Methods: This prospective cohort study was conducted according to STARD guidelines; enrolled 120 cases requiring DLT intubation. After DLT insertion, all patients were examined by stethoscope, then by LUS for determination of DLT position, and then confirmed by FOB in the same patient. Results: Three patients dropped out due to failed intubation, and only 117 cases were analyzed. Time was significantly longer for LUS than for auscultation and FOB and was insignificantly different between auscultation and FOB. Auscultation had 76.14% sensitivity, 34.48% specificity, and 65.81% accuracy in the determination of correct DLT placement. LUS had 92.05% sensitivity, 79.31% specificity, and 88.89% accuracy in detecting correct DLT placement. There was substantial agreement between LUS and FOB (κ = 0.705) and poor agreement between auscultation and FOB (κ = 0.104). Conclusions: LUS can be used as a simple, noninvasive tool for detecting DLT placement with a substantial agreement with FOB.

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