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

Abstract

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Background:The size and depth of the double-lumen tube (DLT) are important for one-lung ventilation (OLV). In patients of a short stature, it is difficult to perform OLV successfully. We designed this study to evaluate the dimensions and margin of safety of the left main bronchi in patients of a short stature for appropriate OLV. Methods: Chest computed tomography (CT) scans of 241 patients (22 male, 219 female) of a short stature (height below 155 cm) were analyzed retrospectively. The diameters of the trachea (DT), the right and left main bronchi (DR and DL), and the lengths of the right and left main bronchi (LR and LL) were measured at the coronal section of the chest CT scans using a picture archiving communication system program. Results: There were no significant correlations between the heights and lengths of the right and left main bronchi. In addition, the ages and weights of the patients showed no significant correlations with the airway dimensions. The lengths of the bronchial lumen of the left-sided Mallinckrodt DLT show variations of 3 to 5.5 mm with tubes of identical sizes. The margin of safety is 13.8 ± 4.1 mm assuming that appropriately sized DLTs are inserted. Conclusions: For successful and safe OLV in patients of a short stature, anesthesiologists should consider the length of the main bronchus and the actual length of the bronchial lumen of the DLT.

Depth of double-lumen endobronchial tube: a comparison between real practice and clinical recommendations using height-based formulae

“…It was 24-28 mm for Human-Broncho TM and 30-31 mm for Shiley TM . Therefore, the left bronchial limb of the DLT has a safety margin of approximately 15-20 mm, which had been demonstrated in previous investigations on the measurement using FOB and CT scan in Korean patients [19,20]. The differences between the average values of measured and calculated depths in the current investigation was < 20 mm.…”

Risk factors for intraoperative hypoxemia during monopulmonary ventilation: an observational study

“… 11 Lee et al found that patients of short stature have a greater chance of having a short left main bronchus and should be intubated with a DLT smaller than 35 Fr to prevent desaturation. 13 Further, we directly found that patients with left main bronchi <4 cm who were intubated with a double-lumen tube larger than 32 Fr may easily experience desaturation during monopulmonary ventilation.…”

“… 11 In patients with a very short left main bronchus, the cuff-tip length is longer than the length of the left bronchus, and the tip of the double-lumen tube will easily obstruct the orifice of the left upper lobe. 12 , 13 Even if the double-lumen tube is withdrawn, the bronchial cuff could still herniate to the carina. Either cuff leakage or excessive airway pressure could occur during one-lung ventilation.…”

Effects of small tidal volume and positive end-expiratory pressure on oxygenation in pressure-controlled ventilation-volume guaranteed mode during one-lung ventilation

“…Development of one-lung ventilation (OLV) in anesthesiology has greatly influenced the development of lung surgery. During OLV, respiration is achieved only with a dependent lung, and the anesthesiologist must prevent hypoxemia due to increased shunting, as well as lung injury due to increased airway pressure, in contrast with two-lung ventilation [1-4]. According to previous studies comparing oxygenation rates between different ventilator modes during OLV, improvement in oxygenation in volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) showed moderate differences in accordance with pulmonary function.…”