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Shah SB, Hariharan U, Chawla R. Choosing the correct-sized adult double-lumen tube: Quest for the holy grail. Ann Card Anaesth 2023; 26:124-132. [PMID: 37706375 PMCID: PMC10284481 DOI: 10.4103/aca.aca_140_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/03/2022] [Accepted: 10/12/2022] [Indexed: 09/15/2023] Open
Abstract
Appropriate size selection of double-lumen tubes (DLTs) for one-lung ventilation (OLV) in adults is still a humongous task. Several important factors are to be considered like patient height, gender, tracheal diameter, left main bronchial diameter, and cricoid cartilage transverse diameter. In addition to radiological assessment of the airway diameters, the manufacturing details of the particular DLT being used also play a significant role in size selection. Optimal positioning of the appropriately sized DLT is indispensable to avoid complications like airway trauma, cuff rupture, hypoxemia, and tube displacement. It is imperative to know whether the one-size-fits-all dictum holds for DLT size selection as claimed by certain studies. Further randomized studies are required for crystallizing standard protocols ascertaining the correct DLT size. This systematic review article highlights the various parameters employed for DLT size selection and explores the newer DLTs used for adult OLV.
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Affiliation(s)
- Shagun Bhatia Shah
- Department of Anaesthesia and Critical Care, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - Uma Hariharan
- Department of Anaesthesiology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, CHS, New Delhi, India
| | - Rajiv Chawla
- Department of Anaesthesia and Critical Care, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
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Wajima Z, Shiga T, Imanaga K. Comparisons of the segments of left-sided double-lumen tracheobronchial tubes as industrial products. BMC Anesthesiol 2022; 22:177. [PMID: 35676618 PMCID: PMC9175383 DOI: 10.1186/s12871-022-01698-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 05/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although there are at least seven manufacturers producing left-sided double-lumen tubes (DLTs), there have been few reports comparing the segments of these DLTs. In this study, we compared various segments of left-sided DLTs further. MATERIALS AND METHODS We examined five manufacturers' left-sided DLTs: Mallinckrodt, Portex, Rüsch, Sheridan, and Daiken-medical. We conducted the following six trials or measurements, and three supplemental trials or measurements: First, we tried to pass various sizes of steel balls down each lumen in order from the smallest (3 mm) to largest (4.5 mm). If the ball passed on the first attempt, we tried just once; otherwise, we made a second attempt. Second, we measured the external diameter of tracheal and bronchial cuff using a profile projector. Third, we measured the length of the cuff and tip of the bronchial segment of the tubes using the profile projector. Fourth, we measured various lengths of the tubes. Fifth, we measured the external diameter of both lumens and the tubules for tracheal and bronchial cuff inflation. Finally, we measured various cross-sectional areas including the tracheal lumen, bronchial lumen, and tubules for cuff inflation. We also conducted three supplemental studies. First, we measured air volume in the cuff when intracuff pressure equaled 2 or 3 kPa. Second, we defined the configuration of the tracheal and bronchial cuffs. Third, we defined the presence or absence of bevels and also measured the angle of the bevels using the profile projector. RESULTS We performed nine trials and measurements and found large disparities between each manufacturer's tubes. CONCLUSIONS The large disparities found between the measurements of the five manufacturers' tubes may be due to different lots or changes in specifications made by each manufacturer. We found tubes exhibiting lower quality, such as deformations, and non-universal and inconsistent sizing, in the comparison of the manufacturers' tubes. Practitioners should be aware of the features and aspects of these tubes.
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Affiliation(s)
- Zen'ichiro Wajima
- Department of Anesthesia, Seijin Hospital, 3-2-1 Shimane, Adachi-ku, Tokyo, 121-0815, Japan. .,Department of Anesthesiology, Saitama Medical University Hospital, Moroyama, Saitama, 350-0495, Japan.
| | - Toshiya Shiga
- Department of Anesthesiology and Intensive Care Medicine, School of Medicine, International University of Health and Welfare, Chiba, 286-8686, Japan
| | - Kazuyuki Imanaga
- Department of Anesthesia, Shonan Kamakura General Hospital, Kanagawa, 247-8533, Japan
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Suvvari P, Kumar B, Singhal M, Singh H. Comparison between computerized tomography-guided bronchial width measurement versus conventional method for selection of adequate double lumen tube size. Ann Card Anaesth 2020; 22:358-364. [PMID: 31621669 PMCID: PMC6813693 DOI: 10.4103/aca.aca_117_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Selection of adequate size double lumen tube (DLT) is complicated by marked inter-individual variability in morphology and dimensions of tracheobronchial tree. Computerized tomography (CT)-guided left bronchus width measurement has been used to predict adequate size DLT in European and Singapore population; however, no such data exist for Indian population who are racially different. We compared the effect of DLT size selection based on CT-guided bronchial width measurement to the conventional method of DLT selection on the adequacy of both lungs isolation and on the safety margin of right-sided DLT. Methods: Fifty-five adults scheduled to undergo thoracotomy were enrolled in this prospective observational study. An appropriate size left- or right-sided DLT with outer diameter 0.5–1 mm smaller than the CT-measured bronchial width was selected for the isolation of lungs. Adequacy of separation was checked using fiberoptic bronchoscope. The safety margin of selected right-sided DLT size was calculated from CT-measured right upper lobe bronchus width and diameter of right upper lobe ventilation slot of the DLT. Results: Adequate separation of lungs was achieved in 92.7% of studied population, 90.9% in males, and 95.4% in females. Among these, 54.9% patients required different sized DLT as compared to conventional method. Overall safety of margin of right-sided DLTs was comparable between two methods of DLT selection (median [IQR] 4.8 (3.5–6.8) vs. 6.59 (3.5–7.8), P = 0.317). DLT size with adequate isolation of lung correlated with height, tracheal width (TW) on chest X-ray, and age of the patients. A formula to calculate DLT size based on these variable was derived. Conclusion: CT-measured bronchial width predicts the appropriate DLT size better than conventional method. In the absence of CT scan facility, patient height, age, and chest X-ray TW may be used to predict DLT size with reasonable accuracy.
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Affiliation(s)
- Praneeth Suvvari
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhupesh Kumar
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manphool Singhal
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harkant Singh
- Department of Cardiothoracic and Vascular Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Dimensional Variations of Left-Sided Double-Lumen Endobronchial Tubes. Anesthesiol Res Pract 2019; 2019:3634202. [PMID: 31915436 PMCID: PMC6930798 DOI: 10.1155/2019/3634202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 09/05/2019] [Indexed: 11/17/2022] Open
Abstract
Background Tube size selection is critical in ventilating patients' lungs using double-lumen endobronchial tubes (DLTs). Little information about relevant parameters is readily available from manufacturers. The aim of this study is to provide reference data for relevant dimensions of conventionally available DLTs. Methods In this study in a benchmark in vitro setup, several dimensional parameters of four sizes of left-sided double-lumen endobronchial tubes from six different manufacturers were assessed, such as distances and diameters of tube shaft, cuff lengths, and diameters as well the angle at the tip. Results Endobronchial tubes of ostensibly the same size revealed wide variation in measured parameters between brands from different manufacturers. In some parameters, there was an overlap between different sizes from the same manufacturer, i.e., diameters and distances did not increase with increasing nominal endobronchial tube size. The information about dimensions of endobronchial tubes provided by manufacturers' leaflets is insufficient. Conclusions Endobronchial tube size selection carries unnecessary uncertainty because clinically relevant parameters are unknown and vary considerably between different manufacturers.
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Yao HY, Liu TJ, Lai HC. [Risk factors for intraoperative hypoxemia during monopulmonary ventilation: an observational study]. Rev Bras Anestesiol 2019; 69:390-395. [PMID: 31387740 DOI: 10.1016/j.bjan.2019.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 02/22/2019] [Accepted: 03/03/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Left double-lumen endotracheal tubes have been widely used in thoracic, esophageal, vascular, and mediastinal procedures to provide lung separation. Lacking clear objective guidelines, anesthesiologists usually select appropriately sized double-lumen endotracheal tubes based on their experience with 35 and 37Fr double-lumen endotracheal tubes, which are the most commonly used. We hypothesized the patients with a left main bronchus of shorter length (<40mm) had a greater chance of experiencing desaturation during one lung ventilation, due to obstruction in the orifice of the left upper lobe with the bronchial tube. METHODS We included 360 patients with a left double-lumen intubated between September 2014 and August 2015. The patient's age, sex, height, weight, and underlying disease were recorded along with type of surgical procedure and the desaturation episodes. In addition, the width of the trachea and the width and length of the left bronchus were measured using computed tomography. RESULT Patients with a left main bronchus length of less than 40mm who underwent intubation with a left double-lumen endotracheal tubes had significantly higher incidence of desaturation (Odds Ratio (OR: 8.087)) during one-lung ventilation. Other related factors of patients identified to be at risk of developing hypoxia were diabetes mellitus (OR: 5.368), right side collapse surgery (OR: 4.933), and BMI (OR: 1.105). CONCLUSIONS We identified that patients with a left main bronchus length of less than 40mm have a great chance of desaturation, especially if other desaturation risk factors are present.
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Affiliation(s)
- Han-Yun Yao
- Taipei Medical University, Wan Fang Hospital, Department of Anesthesiology, Taipei, Taiwan; Taichung Veterans General Hospital, Cardiovascular Center and Department of Medicine, Chiayi, Taiwan
| | - Tsun-Jui Liu
- National Yang-Ming University, School of Medicine, Department of Medicine, Taipei, Taiwan; Taichung Veterans General Hospital, Cardiovascular Center and Department of Medicine, Chiayi, Taiwan
| | - Hui-Chin Lai
- National Yang-Ming University, School of Medicine, Department of Medicine, Taipei, Taiwan; Taichung Veterans General Hospital, Cardiovascular Center and Department of Medicine, Chiayi, Taiwan; Taichung Veterans General Hospital, Department of Anesthesiology, Taichung, Taiwan.
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6
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Yao HY, Liu TJ, Lai HC. Risk factors for intraoperative hypoxemia during monopulmonary ventilation: an observational study. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2019. [PMID: 31387740 PMCID: PMC9391880 DOI: 10.1016/j.bjane.2019.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Left double-lumen endotracheal tubes have been widely used in thoracic, esophageal, vascular, and mediastinal procedures to provide lung separation. Lacking clear objective guidelines, anesthesiologists usually select appropriately sized double-lumen endotracheal tubes based on their experience with 35 and 37 Fr double-lumen endotracheal tubes, which are the most commonly used. We hypothesized the patients with a left main bronchus of shorter length (<40 mm) had a greater chance of experiencing desaturation during one lung ventilation, due to obstruction in the orifice of the left upper lobe with the bronchial tube. Methods We included 360 patients with a left double-lumen intubated between September 2014 and August 2015. The patient's age, sex, height, weight, and underlying disease were recorded along with type of surgical procedure and the desaturation episodes. In addition, the width of the trachea and the width and length of the left bronchus were measured using computed tomography. Result Patients with a left main bronchus length of less than 40 mm who underwent intubation with a left double-lumen endotracheal tubes had significantly higher incidence of desaturation (Odds Ratio (OR: 8.087)) during one-lung ventilation. Other related factors of patients identified to be at risk of developing hypoxia were diabetes mellitus (OR: 5.368), right side collapse surgery (OR: 4.933), and BMI (OR: 1.105). Conclusions We identified that patients with a left main bronchus length of less than 40 mm have a great chance of desaturation, especially if other desaturation risk factors are present.
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Ma S, Adjavon S, Bouchiha N, Castelli C, Fischler M, Mellot F, Le Guen M. Automated measurement of tracheal and main bronchial diameters: a feasibility study. Minerva Anestesiol 2019; 85:1281-1288. [PMID: 31106553 DOI: 10.23736/s0375-9393.19.13458-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND A thoracic computed tomography scan is rarely used to help choose the appropriate double-lumen tube. Nowadays, bronchial measurements can be automated using dedicated software. The aim of this prospective monocentric study was to compare manual and automated measurements of the diameter of the trachea and both main bronchi in adult patients free from a history of lung surgery or disease. METHODS Diameters of the trachea and of the main stem bronchi were measured by trained physicians or automatically using Thoracic Volume Computer Assisted Reading software (GE Healthcare, Chicago, IL, USA). Manual measurements were considered as the goal standard. RESULTS Two hundred and forty-three patients were assessed for eligibility, 216 were allocated to intervention and 173 analyzed: 102 males and 71 females (61.4±13.9 years, 169.7±9.4 cm, 73.3±16.8 kg). Reliability between the two investigators was poor (20.8±9.0% of measurements with a difference >10%). Intraclass correlation coefficient (ICC) and its confidence interval at 95% (ICC [95% CI]) was 0.97 [0.96; 0.98] for the maximal diameter and 0.94 [0.92; 0.95] for the minimal diameter of the trachea (P<0.01 for both). ICC [95% CI] was 0.97 [0.94; 0.98] for the maximal diameter and 0.93 [0.90; 0.95] for the minimal diameter of the right main bronchus (P<0.01 for both). ICC [95% CI] was 0.96 [0.95; 0.97] for the maximal diameter and 0.93 [0.90; 0.95] for the minimal diameter of the left main bronchus (P<0.01 for both). CONCLUSIONS This feasibility study has mixed results since automated measurements were not feasible in around 20% of the cases.
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Affiliation(s)
- Sabrina Ma
- Department of Anesthesiology, Foch Hospital, Suresnes, France.,Versailles Saint-Quentin-en-Yvelines University, Versailles, France
| | - Shérifa Adjavon
- Department of Anesthesiology, Foch Hospital, Suresnes, France.,Versailles Saint-Quentin-en-Yvelines University, Versailles, France
| | - Nabil Bouchiha
- Department of Anesthesiology and Surgical Intensive Care Units, Henri Mondor Hospital, Créteil, France.,Créteil Val de Marne University, Créteil, France
| | - Caroline Castelli
- Unit of Anesthesiology and Intensive Care, Trauma Center, Nord Hospital, Assistance Publique Hôpitaux de Marseille, Marseille, France.,Aix Marseille University, Marseille, France
| | - Marc Fischler
- Department of Anesthesiology, Foch Hospital, Suresnes, France - .,Versailles Saint-Quentin-en-Yvelines University, Versailles, France
| | | | - Morgan Le Guen
- Department of Anesthesiology, Foch Hospital, Suresnes, France.,Versailles Saint-Quentin-en-Yvelines University, Versailles, France
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8
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Use of tracheal ultrasound combined with clinical parameters to select left double-lumen tube size. Eur J Anaesthesiol 2019; 36:215-220. [DOI: 10.1097/eja.0000000000000939] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Jeon Y, Ryu HG, Bahk JH, Jung CW, Goo JM. A New Technique to Determine the Size of Double-lumen Endobronchial Tubes by the Two Perpendicularly Measured Bronchial Diameters. Anaesth Intensive Care 2019; 33:59-63. [PMID: 15957692 DOI: 10.1177/0310057x0503300109] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The cross-section of the mainstem bronchi is not completely round. For preoperative selection of a double-lumen endobronchial tube size, it may be necessary to measure the mediolateral and the anteroposterior bronchial diameters, which can be measured respectively on chest radiograph and computed tomography. With Internal Review Board approval and patients’ informed consent, 105 elective thoracic surgical patients who needed left-sided double-lumen tubes were enrolled. Double-lumen tube size was selected depending on the arithmetic mean of the mediolateral and anteroposterior bronchial diameters. Moreover, the outer diameters of the bronchial tube should be smaller than both mediolateral and anteroposterior diameters. The recommended bronchial diameter for each double-lumen tube size was chosen so that the mean of the two bronchial diameters was 0 to 2.0 mm larger than the upper limit of 95% confidence interval of the averaged outer diameter of the bronchial tube of the selected double-lumen tube. In no case was the predicted double-lumen tube size inappropriate. Generally, anteroposterior bronchial diameters appeared to be different from mediolateral diameters (P=0.001). The double-lumen tube size to be selected based on only one bronchial diameter was different from the one selected based on two perpendicularly measured bronchial diameters in 54.3% of patients (57/105). Preoperative selection of the double-lumen tube size based on the anteroposterior, mediolateral and mean bronchial diameters seems to be useful in that this may obviate the need to change an inappropriately sized double-lumen tube and may be helpful in reducing the related complications.
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Affiliation(s)
- Y Jeon
- Department of Anesthesiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Seo JH, Bae J, Paik H, Koo CH, Bahk JH. Computed Tomographic Window Setting for Bronchial Measurement to Guide Double-Lumen Tube Size. J Cardiothorac Vasc Anesth 2018; 32:863-868. [DOI: 10.1053/j.jvca.2017.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Indexed: 11/11/2022]
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Abstract
The understanding of the physiology and management of one-lung ventilation (OLV) has advanced over the last two decades. OLV induces an obligatory shunt through the nonventilated lung that causes varying degrees of arterial hypoxemia. Shunt may also occur in the venti lated lung. The optimal mode of ventilation of the dependent lung has not been well defined. The optimal tidal volume, respiratory rate, inspired oxygen concen tration, and positive end-expiratory pressure (PEEP) during OLV are not known. Functional residual capacity (FRC) of the ventilated lung can be lower than during two-lung ventilation, causing atelectasis and arterial hypoxemia. Patients who desaturate might be expected to show improvement in oxygenation with dependent lung PEEP, because of increased FRC and reduced V/Q mismatch. Not all patients have low lung volumes, and not all patients who have low lung volumes will desatu rate. Therefore, prophylactic PEEP is not usually neces sary or appropriate. Because the predominant cause of hypoxemia during OLV is shunt in the nondependent lung, therapies to improve arterial oxygenation during OLV should be primarily directed toward the nondepen dent lung. Partial reinflation of the nondependent lung with O2will reduce the physiological shunt fraction of the lung. Continuous positive airways pressure (CPAP) is an effective prophylactic and therapeutic treatment for hypoxemia. All studies examining CPAP have found it to be effective, provided it is preceded by lung reinflation.
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Affiliation(s)
| | - Simon C. Body
- Department of Anesthesia, Brigham and Women's Hospital, Boston, MA
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Wani TM, Rafiq M, Terkawi R, Moore-Clingenpeel M, AlSohaibani M, Tobias JD. Cricoid and left bronchial diameter in the pediatric population. Paediatr Anaesth 2016; 26:608-12. [PMID: 27061440 DOI: 10.1111/pan.12896] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/10/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Lung isolation in the pediatric population can be problematic. The diameter and length of the right and left mainstem bronchi are not well described in young children. Information regarding these measurements may help determine the appropriate size of endotracheal tubes for endobronchial intubation as well as the development of lung isolation devices for the pediatric population. The present study is based on computed tomography (CT) measurements to evaluate airway dimensions. The goal of this study was to define the relationship between the diameters of the left mainstem bronchus (LMSB) and the cricoid ring, and to study the effect of age, weight, and height on these dimensions. METHODS The two-dimensional CT images of 102 children, ranging in age from 1 month to 10 years, undergoing radiological evaluation unrelated to airway symptomatology were examined. The cricoid dimensions (anteroposterior and transverse diameters) were measured using transverse plane images. The LMSB diameter was measured below the carina along the long axis of left main bronchus. Univariate regression analysis was used to determine whether one or more of the variables (age, gender, height, weight) had a predictable relationship with the cricoid and the LMSB diameters. RESULTS The cricoid as well as the LMSB diameters increase with age, height, and weight. The relationship between the cricoid diameter and the LMSB diameter remains constant across all ages with a ratio of 0.78 ± 0.14. This ratio was slightly larger for girls than boys (0.81 ± 0.16 vs 0.77 ± 0.13). CONCLUSION The cricoid to LMSB ratio (relationship) remains constant with respect to age, height, and weight.
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Affiliation(s)
- Tariq M Wani
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Anesthesia, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mahmood Rafiq
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Rayan Terkawi
- Department of Anesthesia, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Mazen AlSohaibani
- Department of Anesthesia, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Joseph D Tobias
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
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Spaeth J, Ott M, Karzai W, Grimm A, Wirth S, Schumann S, Loop T. Double-lumen tubes and auto-PEEP during one-lung ventilation. Br J Anaesth 2016; 116:122-30. [DOI: 10.1093/bja/aev398] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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14
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Hannallah M, Johnson W, Krishnan P. Revisiting the Question of the Appropriate Left Double-Lumen Endobronchial Tube Size for an Individual Patient. J Cardiothorac Vasc Anesth 2014; 28:e53-4. [DOI: 10.1053/j.jvca.2014.04.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Indexed: 11/11/2022]
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15
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Licker M, Le Guen M, Diaper J, Triponez F, Karenovics W. Isolation of the lung: Double-lumen tubes and endobronchial blockers. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2014. [DOI: 10.1016/j.tacc.2014.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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16
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Sanjay PS, Miller SA, Corry PR, Russell GN, Pennefather SH. The effect of gel lubrication on cuff leakage of double lumen tubes during thoracic surgery*. Anaesthesia 2006; 61:133-7. [PMID: 16430565 DOI: 10.1111/j.1365-2044.2005.04440.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
High-volume, low-pressure tracheal cuffs of disposable double lumen tubes may offer limited protection to the dependent lung if fluid leaks through folds in the inflated cuffs. This study was undertaken to determine the incidence of fluid leakage past the tracheal cuff and whether gel lubrication reduces the incidence. Fifty-five patients were randomly assigned to receive a double lumen tube with or without gel lubrication. The dependent lung was intubated. With the patient in the lateral position, methylthionium chloride was administered above the tracheal cuff via a pre-attached catheter. Fibreoptic bronchoscopy was performed to determine if dye had passed the tracheal cuff. Three patients were excluded. Dye leakage was seen in 12/27 and 3/25 patients in the unlubricated and lubricated group, respectively (p = 0.014). Gel lubrication significantly reduces fluid leakage past the tracheal cuff of a double lumen tube and should be considered for all thoracic surgical patients requiring one-lung ventilation.
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Affiliation(s)
- P S Sanjay
- Department of Anaesthesia, Cardiothoracic Centre, Thomas Drive, Liverpool L14 3PE, UK
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17
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Brodsky JB, Lemmens HJM. Tracheal width and left double-lumen tube size: a formula to estimate left-bronchial width. J Clin Anesth 2005; 17:267-70. [PMID: 15950850 DOI: 10.1016/j.jclinane.2004.07.008] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2004] [Accepted: 07/20/2004] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVE To determine which patient parameters best predict left bronchial width (LBW) when selecting the correct size double-lumen tube (DLT). If LBW is known, a DLT that will fit that bronchus can be chosen. DESIGN Prospective study. SETTING University medical center. PATIENTS Three hundred twenty-one consecutive patients scheduled for thoracic surgery and for whom there was a chest radiograph and for whom tracheal width (TW) and LBW could be measured. MEASUREMENTS Tracheal width and LBW were directly measured from the chest radiograph. Patient demographic data were recorded and then analyzed to see which factor(s) best predicted LBW. Parameters often used for DLT selection (age, sex, height, and weight) as well as TW were compared by univariate and multivariate statistical analysis to see which factor(s) most accurately predicted LBW. MAIN RESULTS There were weak but significant correlations between age and height and LBW in men, and height and LBW in women. Multivariate statistical analysis showed that, for both men and women, TW was the best predictor of LBW. Sex, height, and weight did not improve predictability over TW alone. The equation that best predicts LBW for both sexes is: LBWmm = (0.50)(TWmm) + 3.7 mm. This model explains 46% of the variance in LBW. As structures measured from a chest radiograph are magnified by 10%, the formula to predict LBW, which normalizes for this magnification factor, is: LBWmm = (0.45)(TWmm(CXR)) + 3.3 mm. CONCLUSIONS Direct airway measurement is the most accurate way to select an appropriate DLT. However, when direct measurement of LBW cannot be performed, estimating LBW from TW is a better predictor of LBW than either sex, height, or weight.
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Affiliation(s)
- Jay B Brodsky
- Department of Anesthesia, Stanford University School of Medicine, Stanford, CA 94305, USA.
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Abstract
The diameter of the left main bronchus is the determining dimension when selecting the size of a left tracheobronchial (double-lumen) tube for lung separation. However, this information is not given by any manufacturer, either on the tube or in the package insert. This paper describes the lengths and diameters of the deflated bronchial cuff segment of left tracheobronchial tubes in common use. One hundred and seventy-one left tracheobronchial tubes ranging in size from 28 to 41 nominal French gauge from four manufacturers were measured. There was wide variation between tubes of the same nominal size from the same manufacturer. For tubes of the same size from the same manufacturer, the diameter of the segment with the deflated bronchial cuff varied by more than 1 mm in diameter in some instances. The diameter of the bronchial cuff segment did not consistently decrease as the nominal size decreased even for the same manufacturer. There was major overlap in diameters of the bronchial segments between Fr 41, Fr 39, and Fr 37 tubes from most manufacturers, so that some of the Fr 39 tubes have a bronchial cuff segment diameter as much as 0.5 mm larger than the Fr 41 tube. It is concluded that the current French gauge markings on left tracheobronchial tubes are of very limited value in determining the appropriate size to be selected for a patient. More accurate and consistent dimensions of tracheobronchial tubes are required to improve clinical selection.
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Affiliation(s)
- W J Russell
- Department of Anaesthesia and Intensive Care, Royal Adelaide Hospital, North Terrace, Adelaide, Australia
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Sivalingam P, Tio R. Tension pneumothorax, pneumomediastinum, pneumoperitoneum, and subcutaneous emphysema in a 15-year-old Chinese girl after a double-lumen tube intubation and one-lung ventilation. J Cardiothorac Vasc Anesth 1999; 13:312-5. [PMID: 10392684 DOI: 10.1016/s1053-0770(99)90270-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- P Sivalingam
- Department of Anaesthesia, National University Hospital, Singapore
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Chow MY, Liam BL, Thng CH, Chong BK. Predicting the size of a double-lumen endobronchial tube using computed tomographic scan measurements of the left main bronchus diameter. Anesth Analg 1999; 88:302-5. [PMID: 9972745 DOI: 10.1097/00000539-199902000-00014] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED We investigated the use of chest computer tomographic (CT) scan measurement of the left mainstem bronchial diameter to predict the correct left-sided double-lumen endobronchial tube (DLT) size in Asian patients who may require smaller DLT sizes. Fifty consecutive Asian adults aged 17-80 yr with preoperative chest CT scans undergoing elective thoracic surgery were entered into the study. The measurements of the left main bronchus diameter were made by using the electronic calipers of the spiral scanner to the nearest millimeter. The sizes of DLT selected were 32F, 35F, 37F, 39F, and 41F for left main bronchus diameters of <10 mm, 10 mm, 11 mm, 12 mm, and >12 mm, respectively. All DLT placements were confirmed and positioned by using fiberoptic bronchoscopy. The tracheas of all patients were successfully intubated with the predicted DLT sizes. Thirty-four patients (68%) were predicted to require smaller DLTs (37F or smaller). Six patients were correctly predicted to receive 32F DLTs. Twelve patients (24%) received an oversized DLT, but none received an undersized DLT. The overall positive predictive value for the male and female patients was 84.4% and 61.1%, respectively. Our study showed that CT scan measurements of the diameter of the left bronchus were especially useful in choosing smaller DLTs. IMPLICATIONS We used computer tomographic scans to measure the diameter of the left mainstem bronchus, then selected the size of the left-sided double-lumen endobronchial tube (DLT) accordingly. We found that we could predict the sizes of the DLT fairly accurately, especially the smaller DLTs.
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Affiliation(s)
- M Y Chow
- Department of Anesthesia, Singapore General Hospital and Tan Tock Seng Hospital, Singapore.
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21
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Chow MYH, Liam BL, Thng CH, Chong BK. Predicting the Size of a Double-Lumen Endobronchial Tube Using Computed Tomographic Scan Measurements of the Left Main Bronchus Diameter. Anesth Analg 1999. [DOI: 10.1213/00000539-199902000-00014] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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22
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Chow MYH, Liam BL, Lew TWK, Chelliah RY, Ong BC. Predicting the Size of a Double-Lumen Endobronchial Tube Based on Tracheal Diameter. Anesth Analg 1998. [DOI: 10.1213/00000539-199807000-00033] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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23
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Chow MY, Liam BL, Lew TW, Chelliah RY, Ong BC. Predicting the size of a double-lumen endobronchial tube based on tracheal diameter. Anesth Analg 1998; 87:158-60. [PMID: 9661566 DOI: 10.1097/00000539-199807000-00033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED We assessed whether using the tracheal diameter to predict the correct size of the left double-lumen endobronchial tube (DLT) could be used for our generally smaller sized Asian patients. Sixty-six consecutive adult patients under anesthesia for elective surgery requiring the use of a DLT were studied. The size of the left-sided DLT used was based on the width of patients' trachea measured from the preoperative posterior-anterior chest radiograph. The placement of the DLT was standardized and confirmed with fiberoptic bronchoscopy. The correct size of the DLT was the largest size tube inserted into the left bronchus with a small air leak detectable when the endobronchial cuff was deflated but not exceeding the recommended resting volume when inflated for lung isolation. Using this method of choosing our DLT, we found that an oversized DLT was often chosen especially among our female Asian patients. The overall positive predictive values for the male and female patients were 77.3% and 45.5%, respectively. We postulate that this could be due to our criteria for correct DLT size or that our local Asian patients, especially the females, were smaller and shorter. IMPLICATIONS This study assessed whether the correct double-lumen endobronchial tube size could be predicted from tracheal diameter measurements taken from the chest radiograph. We found that this method of choosing the double-lumen endobronchial tubes was not always reliable.
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Affiliation(s)
- M Y Chow
- Department of Anesthesia, Tan Tock Seng Hospital, Singapore.
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Hannallah M, Benumof JL, Silverman PM, Kelly LC, Lea D. Evaluation of an approach to choosing a left double-lumen tube size based on chest computed tomographic scan measurement of left mainstem bronchial diameter. J Cardiothorac Vasc Anesth 1997; 11:168-71. [PMID: 9105987 DOI: 10.1016/s1053-0770(97)90208-1] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Evaluation of an approach to choosing left double-lumen tube size based on chest computed tomographic (CT) scan measurement of left bronchial diameter. DESIGN Prospective. SETTING The operating rooms of a university hospital. PARTICIPANTS Patients scheduled for elective thoracic surgery. INTERVENTIONS Patients had their left bronchial diameter measured on the preoperative chest CT scan. Left double-lumen tube size for the individual patient was chosen from a protocol based on left bronchial diameter. MEASUREMENTS AND MAIN RESULTS The double-lumen tube size was considered appropriate for the patient if some air leak was detected when the bronchial cuff was deflated and if airtight seal of the left bronchus was obtained with a bronchial cuff volume of 2 mL or less. In 17 of 20 patients, the double-lumen tube size fulfilled both criteria. In 3 women with left bronchi measuring 10 mm or less, the bronchus was sealed without any air in the bronchial cuff of size 35 Fr left double-lumen tubes. In 1 patient, who was excluded from the study, the double-lumen tube size was chosen based on measurement of the left bronchial diameter on chest radiograph because of motion artifact on the chest CT scan. CONCLUSIONS Chest CT scan measurement of left bronchial diameter can successfully guide the choice of left double-lumen tube size for an individual patient. In individuals with a small left bronchus measuring less than 10.0 mm in diameter, currently available adult double-lumen tube sizes will tightly wedge in their bronchus.
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Affiliation(s)
- M Hannallah
- Department of Anesthesiology, Georgetown University Medical Center, Washington, DC 20007, USA
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Brodsky JB, Macario A, Mark JB. Tracheal diameter predicts double-lumen tube size: a method for selecting left double-lumen tubes. Anesth Analg 1996; 82:861-4. [PMID: 8615510 DOI: 10.1097/00000539-199604000-00032] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- J B Brodsky
- Department of Anesthesiology, Stanford University School of Medicine, California, USA
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