A comparison of techniques for placement of double-lumen endobronchial tubes

Boucek, Charles D.; Landreneau, Rodney; Freeman, J. A.; Strollo, Diane C.; Bircher, Nicholas G.

doi:10.1016/s0952-8180(98)00081-6

Cited by 38 publications

(24 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In contrast with the recent study of Boucek and colleagues 3 where the blind (conventional) approach was twice as fast as the directed approach (88 vs 181 s), we found that placement of the double-lumen tube under direct vision reduced considerably the time required for successful intubation and clinical confirmation of the intubation attempt. Our results suggested that the fibreoptic-guided approach would enable the anaesthetist to isolate the lung quickly, particularly in situations where differential ventilation is crucial (e.g.…”

Section: Commentcontrasting

confidence: 99%

Placement of left-sided double-lumen endobronchial tubes: comparison of clinical and fibreoptic-guided placement

Cheong

Koh

1999

British Journal of Anaesthesia

View full text Add to dashboard Cite

We have compared a new intubation manoeuvre using a fibreoptic bronchoscope with conventional blind placement of a double-lumen tube. Thirty adult patients who presented for thoracoscopy requiring one-lung ventilation underwent endobronchial intubation with a double-lumen tube inserted either in the conventional blind way or using a fibreoptic bronchoscope. There were four misplacements of the double-lumen tube using the conventional method but none using the bronchoscope. In addition, the bronchoscope allowed more rapid intubation (mean 106 vs 347 s). The results suggest that the fibreoptic-guided method of inserting the double-lumen tube was a satisfactory alternative to the conventional one.

show abstract

Section: Commentcontrasting

confidence: 99%

Placement of left-sided double-lumen endobronchial tubes: comparison of clinical and fibreoptic-guided placement

Cheong

Koh

1999

British Journal of Anaesthesia

View full text Add to dashboard Cite

show abstract

“…Blind placement, especially in patients with difficult airways, is prone to failure, and while fibreoptic bronchoscopy is commonly used, it increases the procedure time and typically requires an assistant . Many devices, including lighted stylets and video instruments, have been developed to increase the success rate of double‐lumen tube placement, principally by aiding passage of the tube through the vocal cords . Most of these devices, however, do not allow confirmation of placement in the bronchus.…”

Section: Discussionmentioning

confidence: 99%

“…In order to increase the success rate of double‐lumen tube intubation, a number of devices have been developed, including lighted laryngoscopes and video devices to aid advancement past the vocal cords; however, these devices generally do not allow confirmation of correct placement in the bronchus . Overall, the devices appear to improve the success rate of tracheal intubation in cases of difficult airways, but it is unclear if their routine use leads to improvements in outcomes.…”

Section: Introductionmentioning

confidence: 99%

A randomised trial comparing real-time double-lumen endobronchial tube placement with the Disposcope^® with conventional blind placement

et al. 2017

View full text Add to dashboard Cite

Double-lumen endobronchial tube placement is challenging. This study compared double-lumen tube placement with the Disposcope , a wireless videostylet allowing real-time visualisation, with conventional blind placement. Patients undergoing elective thoracic surgery with normal airways requiring one-lung ventilation were randomly allocated into two groups (27 patients in each group). The Disposcope was used to assist left-sided double-lumen tube placement in one group, and conventional blind placement was performed in the control group. Placement in both groups was checked with fibreoptic bronchoscopy. The Disposcope-assisted group had a shorter total mean (SD) placement time (18.6 (2.5) s vs. 21.4 (2.9) s, p < 0.001), laryngoscopy to end of auscultation time (83.4 (3.0) s vs. 93.9 (5.7) s, p < 0.001) and total operation time (130.7 (6.1) s vs. 154.5 (6.3) s, p < 0.001). In the Disposcope-assisted group, the double-lumen tube was inserted in the correct side in all patients (100.0%), whereas in the conventional group, the double-lumen tube was placed in the correct side in 25 (92.6%) patients and in the wrong side in 2 (7.4%) patients; the difference was not significant (p = 0.150). In the Disposcope-assisted group, the double-lumen tube was inserted to the optimal depth in 24 (88.9%) patients, whereas in the conventional group it was inserted to the optimal depth in one (4.0%) patient. The Disposcope increased the success rate of double-lumen tube placement, and shortened the total operation time when compared with standard placement with confirmation using fibreoptic bronchoscopy, and may replace the conventional method.

show abstract

“…After passing through the glottis and 90° counterclockwise rotation, the DLT is advanced into the LMB either blindly or by fiberoptic bronchoscopic (FOB) guidance. Although left-sided DLTs can be placed into the LMB more rapidly by a blind technique [ 2 ], it may be misdirected into the right mainstem bronchus (RMB) because the RMB has a larger internal diameter and diverges from the carina more vertically from the sagittal plane than the LMB [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Misplacement of left-sided double-lumen tubes into the right mainstem bronchus: incidence, risk factors and blind repositioning techniques

et al. 2015

View full text Add to dashboard Cite

BackgroundDouble-lumen endobronchial tubes (DLTs) are commonly advanced into the mainstem bronchus either blindly or by fiberoptic bronchoscopic guidance. However, blind advancement may result in misplacement of left-sided DLTs into the right bronchus. Therefore, incidence, risk factors, and blind repositioning techniques for right bronchial misplacement of left-sided DLTs were investigated.MethodsThis was an observational cohort study performed on the data depository consecutively collected from patients who underwent intubation of left-sided DLTs for 2 years. Patients’ clinical and anatomical characteristics were analyzed to investigate risk factors for DLT misplacements with logistic regression analysis. Moreover, when DLTs were misplaced into the right bronchus, the bronchial tube was withdrawn into the trachea and blindly readvanced without rotation, or with 90° or 180° counterclockwise rotation while the patient’s head was turned right.ResultsDLTs were inadvertently advanced into the right bronchus in 48 of 1135 (4.2 %) patients. DLT misplacements occurred more frequently in females, in patients of short stature or with narrow trachea and bronchi, and when small-sized DLTs were used. All of these factors were significantly inter-correlated each other (P < 0.001). In 40 of the 48 (83.3 %) patients, blind repositioning was successful.ConclusionsSmaller left-sided DLTs were more frequently misplaced into the right mainstem bronchus than larger DLTs. Moreover, we were usually able to reposition the misplaced DLTs into the left bronchus by using the blind techniques.Trial registrationClinicalTrials.gov Identifier: NCT01371773.

show abstract

A comparison of techniques for placement of double-lumen endobronchial tubes

Cited by 38 publications

References 19 publications

Placement of left-sided double-lumen endobronchial tubes: comparison of clinical and fibreoptic-guided placement

Placement of left-sided double-lumen endobronchial tubes: comparison of clinical and fibreoptic-guided placement

A randomised trial comparing real-time double-lumen endobronchial tube placement with the Disposcope^® with conventional blind placement

Misplacement of left-sided double-lumen tubes into the right mainstem bronchus: incidence, risk factors and blind repositioning techniques

Contact Info

Product

Resources

About

A comparison of techniques for placement of double-lumen endobronchial tubes

Cited by 38 publications

References 19 publications

Placement of left-sided double-lumen endobronchial tubes: comparison of clinical and fibreoptic-guided placement

Placement of left-sided double-lumen endobronchial tubes: comparison of clinical and fibreoptic-guided placement

A randomised trial comparing real-time double-lumen endobronchial tube placement with the Disposcope® with conventional blind placement

Misplacement of left-sided double-lumen tubes into the right mainstem bronchus: incidence, risk factors and blind repositioning techniques

Contact Info

Product

Resources

About

A randomised trial comparing real-time double-lumen endobronchial tube placement with the Disposcope^® with conventional blind placement