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

Yoon, Tae-Gyoon; Ryu, Ho-Geol; Kwon, T D; Bahk, Jae Hyon; Chang, Hyewon

doi:10.1007/bf03016286

Cited by 23 publications

(38 citation statements)

References 13 publications

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“…A significant DLT displacement was defined as an inward or outward movement of [ 10 mm from the initial correct position. 9 In the Yoon et al study, 5 the DLT tracheal displacement was 6.3 (5.5) mm in the group without a neck brace. We considered a 50% decrease in the distance of tracheal displacement to be clinically significant.…”

Section: Methodsmentioning

confidence: 86%

“…When patients are turned from the supine to the lateral decubitus position, outward displacement of DLTs usually occurs and may be closely related to neck movement. 2,5 Generally, flexion or extension of the head and neck produces inward or outward displacement of single-lumen tubes or DLTs, respectively. 2,5,10 By restricting head and neck movements with a neck brace, the DLT displacement was minimized during lateral positioning.…”

Section: Discussionmentioning

confidence: 99%

“…Both tracheal and bronchial distances were measured as described previously. 5 To measure the tracheal distance, the tracheal carina was visualized at the tip of the FOB, and a piece of tape was placed on the FOB at the point where it entered the self-sealing diaphragm of the elbow connector. Subsequently, the FOB was withdrawn until its tip was located at the distal opening of the tracheal lumen indicated by the vertical black mark on the DLT, and another piece of tape was placed on the FOB at the point of entry into the selfsealing diaphragm.…”

Section: Methodsmentioning

confidence: 99%

“…Les distances se´parant l'origine de la trache´e de la grande care`ne et de l'origine de la bronche souche jusqu'a`la care`ne de la bronche gauche ont e´te´mesure´es al 'aide d'un bronchoscope chez les patients en decubitus dorsal puis en decubitus lateral. Résultats Le de´placement des DLT (moyenne [e´cart-type]) au cours de la mise en decubitus late´ral a e´te´plus important dans le groupe avec appuie-teˆte que dans le groupe sans appuie-teˆte (respectivement 12,3 [5,6] mm contre 6,8 [5,5] mm dans la trache´e et 11,6 [6,7] mm contre 6,0 [4,6] mm dans la bronche; P \ 0,001). L'incidence d'un de´placement significatif, de´fini comme e´tant [ 10 mm par rapport a`la position initiale, a e´te´supe´rieure dans le groupe avec appuie-teˆte par rapport au groupe sans appuie-teˆte (respectivement, 64 % contre 28 % pour la trache´e et 58 % contre 20 % pour la bronche; P \ 0,001).…”

Section: Résuméunclassified

“…[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.…”

Section: Résumémentioning

confidence: 99%

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

Seo

Hong

Lee

et al. 2012

Can J Anesth/J Can Anesth

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Double-lumen tube placement with the patient in the supine position without a headrest minimizes displacement during lateral positioning La mise en place d'une sonde à double lumière chez un patient en decubitus dorsal sans appuie-tête minimise le risque de déplacement au cours du passage en decubitus latéral Abstract Purpose The correct position of double-lumen tubes (DLTs) is customarily confirmed after tracheal intubation by bronchoscopy with the patient supine on a headrest. However, displacement of DLTs usually occurs during lateral positioning because of neck extension. This study was undertaken to determine whether displacement of DLTs could be minimized during lateral positioning if DLTs were positioned without a headrest. Methods One hundred patients scheduled for thoracic surgery were randomized into two groups (n = 50 each). After tracheal intubation using a headrest, adjustment of DLT position was performed according to group assignment, i.e., either with the headrest in place or without the headrest. Using a bronchoscope, distances from the tracheal opening to the main carina and from the bronchial opening to the left bronchial carina were measured in both the supine and lateral positions. Results Displacement of DLTs [mean (standard deviation)] during lateral positioning was greater in the headrest group than in the no-headrest group [12.3 (6.5) mm vs 6.8 (5.5) mm, respectively, in the trachea; 11.6 (6.7) mm vs 6.0 (4.6) mm, respectively, in the bronchus; P \ 0.001]. The incidence of significant displacement, defined as [ 10 mm from initial correct position, was greater in the headrest group than in the no-headrest group (64% vs 28%, respectively, in the trachea; 58% vs 20%, respectively, in the bronchus; P \ 0.001). Conclusion Displacement of DLTs during lateral positioning appears to be caused primarily by extension of the neck. Correct adjustment of DLT position without a headrest in the supine position is an easy and effective method to minimize DLT displacement during lateral positioning (ClinicalTrials.gov number, NCT01413347). RésuméObjectif La bonne position des sondes a`doubles lumie`res (DLT) est d'ordinaire confirme´e par bronchoscopie apre`s intubation trache´ale chez un patient en decubitus dorsal avec appuie-teˆte. Cependant, ces sondes se de´placent habituellement au cours d'un changement de position en decubitus late´ral en raison d'une extension du cou. Cette e´tude a e´te´entreprise pour de´terminer si le de´placement des DLT pouvait eˆtre minimise´au cours d'un passage en This article is accompanied by an editorial, please see Can J Anesth 2012; 59: this issue.

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Section: Methodsmentioning

confidence: 86%