Continuous Spirometry for Detection of Double-Lumen Endobronchial Tube Displacement

Abstract

Flow-volume and pressure-volume loops were measured with continuous spirometry in 49 patients in whom the trachea was intubated "blindly" with a double-lumen endobronchial tube for thoracic surgery. Nineteen endobronchial tubes were malpositioned by fibreoptic bronchoscopic criteria; 63% of these were suspected because of the configuration of the spirometric loops. During positioning of the patient and during operation, 34.7% of the endobronchial tubes migrated from the initially correct or corrected position. The secondary displacements were identified by abnormal loop configurations and confirmed with fibreoptic bronchoscopy. Continuous spirometric monitoring is helpful in detecting endobronchial tube displacement during intubation and surgery.

Correct positioning of double-lumen tubes

“…1 Quelques minutes après le début de l'intervention, le spiromètre indique une boucle non fermée, témoin d'une fuite. 2 Quelques secondes plus tard, la saturation en oxygène diminue aux alentours de 90%. De plus, le chirurgien vous signale que le poumon droit se gonfle; il est par conséquent impossible de poursuivre la VATS.…”

“…2 A few seconds later, the oxygen saturation levels decrease to the low 90s. Moreover, the surgeon mentions to you that the right lung is inflating; consequently, it is impossible to proceed with the VATS.…”

Lung separation and the difficult airway

“…The tension in the pilot balloon to the inflated bronchial cuff should be noted. If the tube subsequently becomes displaced, 12 the pilot balloon will soften because the cuff will then be partially or completely in the larger trachea. 4 5 DLT position can change intraoperatively due to surgical manipulation, 137 changing patient head position, 104 or both, but turning the patient to the lateral position is a very common cause of outward tube movement.…”

Aspects of Anesthesia for Lung Transplantation

“…Side-stream spirometry is another innovation that may reveal subtle changes in lung mechanics. 35,36 Together, these monitors can lead to the early detection of endobronchial tube misplacement, fluid overload, reperfusion injury, acute allograft rejection, or such simple problems as sputum plugging or collapse by continuously monitoring alveolar-arterial P02 gradient and lung compliance/resistance. Avoidance of intraoperative hypothermia is important, particularly in those patients in whom CPB is to be avoided, because hypothermia can exacerbate pulmonary hypertension, impair coagulation, and delay recovery from anesthesia.…”