Rupture of the left main‐stem bronchus by the tracheal portion of a double‐lumen endobronchial tube

Abstract

We report a rupture of the left main-stem bronchus following the insertion of a left-sided double-lumen endobronchial tube in a 76-yr-old woman with a short trachea. A fiberoptic bronchoscope was not used during the initial insertion of the tube and the depth of insertion resulted in approximately 5 cm in excess of the optimal level for this patient. The rupture had been caused by the tracheal portion of the double-lumen tube. This damage may have been avoided if a fiberoptic bronchoscope was used routinely as an introducer and for positioning of the endobronchial tube under direct vision.

Evaluation of a new double‐lumen endobronchial tube with an integrated camera (VivaSight‐DL™): a prospective multicentre observational study

“…Numerous reports mention tracheal lesions after DLT placement and predicting the optimal insertion depth of a DLT can also be challenging . When placed too deep, a DLT can cause serious complications, including rupture of the main‐stem bronchus . On the other hand, when the bronchial tip is positioned too proximally, its cuff may block air from entering the right main‐stem bronchus.…”

Which device should be considered the best for lung isolation: double-lumen endotracheal tube versus bronchial blockers

“…In adult patients of Asian descent, however, which comprises many individuals of shorter stature (<155 cm), patient height is not a good predictor of depth of insertion for a DLT [18]. An inadvertent deep insertion of a DLT can lead to serious complications, including rupture of the left mainstem bronchus [7]. The depth of insertion for a DLT should be between 27 and 29 cm at the marking of the incisors.…”

“…Selecting an undersized or an oversized DLT has led to serious airway complications [7][8][9], including tracheo-bronchial rupture. Therefore in women of Asian descent or patients of short stature, predicting the size of the DLT is difficult at best.…”

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

“…In patients of a short stature (below 155 cm), however, the height value is not good predictor of the size and depth of the insertion of the DLT [2]. It is difficult to achieve successful OLV in these cases, and these patients are more susceptible to airway injuries [10,11]. Several studies have attempted to determine the depth of insertion and the size of the DLT in patients of a short stature [2,12].…”