Bronchial lumen is the safer route for an airway exchange catheter in double-lumen tube replacement: preventable complication in airway management for thoracic surgery

Abstract

There is no current consensus on which lumen an airway exchange catheter (AEC) should be passed through in double-lumen endotracheal tube (DLT) to exchange for a single-lumen endotracheal tube (SLT) after thoracic surgery. We report an unusual case to provide possible solution on this issue. A 71-year-old man with lung adenocarcinoma had an event of a broken exchange catheter used during a DLT replacement with a SLT, after a video-assisted thoracic surgery. The exchange catheter was impinged at the distal tracheal lumen and snapped during manipulation. All three segments of the catheter were retrieved without further airway compromises. Placement of airway tube exchanger into the tracheal lumen of doublelumen tube is a potential contributing factor of the unusual complication. We suggest an exchange catheter be inserted into the bronchial lumen in optimal depth with the adjunct of video laryngoscope, as the safe method for double-lumen tube exchange.

Double Lumen Endobronchial Tube Placement for Lung Separation via a Tracheostomy Stoma in a Patient Status-Post Laryngectomy

“…Due to increased flow resistance, size, and noxious stimulation, DLTs are not routinely utilized for post-procedure ventilation [ 4 ]. This often necessitates an exchange from a DLT to a SLT in patients who require post-operative ventilation which can be challenging after a prolonged surgery or in patients with difficult airways [ 5 ].…”