Correct positioning of double-lumen tubes

Bussières, Jean S.; Slinger, Peter

doi:10.1007/s12630-012-9689-5

Cited by 5 publications

(3 citation statements)

References 11 publications

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“…The DL-ETT size was based on Brodsky's recommendations 10 and its position was confirmed by flexible bronchoscopy. 11 Intubation and positioning of the DL-ETT was either performed or directly supervised by the attending anesthesiologist.…”

Section: Lung Isolation Managementmentioning

confidence: 99%

Déflation du poumon non ventilé pendant la ventilation unipulmonaire avec un tube endotrachéal à double lumière : une étude randomisée contrôlée d’occlusion de la lumière endobronchique du poumon non ventilé avant l’ouverture pleurale

Somma

Couture

Pelletier

et al. 2021

Can J Anesth/J Can Anesth

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Purpose Lung deflation during one-lung ventilation (OLV) is thought to be faster using a double-lumen endotracheal tube (DL-ETT) than with a bronchial blocker, especially when the non-ventilated lumen is opened to allow egress of air from the operative lung. Nevertheless, ambient air can also be entrained into the non-ventilated lumen before pleural opening and subsequently delay deflation. We therefore hypothesized that occluding the non-ventilated DL-ETT lumen during OLV before pleural opening would prevent air entrainment and consequently enhance operative lung deflation during video-assisted thoracoscopic surgery (VATS). Methods Thirty patients undergoing VATS using DL-ETT to allow OLV were randomized to having the lumen of the operative lung either open (control group) or occluded (intervention group) to ambient air. The primary outcome was the time to lung collapse evaluated intraoperatively by the surgeons. The T 50 , an index of rate of deflation, was also determined from a probabilistic model derived from intraoperative video clips presented in random order to three observers. ResultsThe median [interquartile range] time to lung deflation occurred faster in the intervention group than in the control group (24 [20-37] min vs 54 min,

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Section: Lung Isolation Managementmentioning

confidence: 99%

Déflation du poumon non ventilé pendant la ventilation unipulmonaire avec un tube endotrachéal à double lumière : une étude randomisée contrôlée d’occlusion de la lumière endobronchique du poumon non ventilé avant l’ouverture pleurale

Somma

Couture

Pelletier

et al. 2021

Can J Anesth/J Can Anesth

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“…However, if the DLT is displaced, it may cause difficulties in maintaining one-lung ventilation and operation procedures. Even though the tube may be positioned correctly after intubation, DLT displacement has been reported during lateral position change [2]. Neck movement is known to influence DLT position [3].…”

Section: Double-lumen Endobronchial Tube (Dlt)mentioning

confidence: 99%

Comparison between Displacement of PVC and Silicone DoubleLumen Endobronchial Tube during Lateral Positioning

2018

ARC Journal of Anesthesiology

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Background: A position change after placing a double-lumen endobronchial tube (DLT) frequently results in tube displacement. In this study, we compared displacement of polyvinyl chloride (PVC) and silicone DLTs during lateral positioning. Methods: We enrolled 80 patients undergoing thoracic surgery whose positions were changed to lateral decubitus after DLT insertion. After DLT intubation, the distance (TD) between the carina and tracheal opening of the DLT was measured with a bronchoscope in both supine and lateral positions. We also measured the distances (BD) between the left second carina and left bronchial opening of the DLT. DLT movement was measured by subtracting the tracheal (ΔTD) and bronchial distances (ΔBD) in the supine position from those in the lateral position. Results: The ΔTD and ΔBD differed significantly between the PVC and silicone groups mm) for PVC vs. silicone DLTs, respectively]. Conclusion: A silicone DLT can reduce displacement of DLT during lateral position change when compared with a PVC DLT.

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“…A deeper position may be used to minimize herniation of the bronchial cuff at the carinal level. 2,3 This approach increases the importance of monitoring the bronchial environment distal to the bronchial lumen, which cannot be achieved with the use of the VivaSight DLT.…”

Section: To the Editormentioning

confidence: 99%

Safe and effective positioning of a left-sided double-lumen tube

Couture

Bussières

2015

Can J Anesth/J Can Anesth

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To the Editor,We read with great interest the paper by Schuepbach et al 1 describing their randomized trial that compared the VivaSight double-lumen tube (DLT) with a conventional left-sided double-lumen tube (L-DLT). It is an interesting study, but we have some concerns about the purpose of the VivaSight DLT.The primary objective of the study was to compare the intubation time using the VivaSight DLT with that of a conventional L-DLT. Intubation time was defined by the time interval from the beginning of the laryngoscopy to confirmation of placement by auscultation. Results show a significantly faster mean (SD) time to successful intubation with the VivaSight DLT than with the conventional L-DLT [63 (58) sec vs 97 (84) sec, respectively; P = 0.03]. One could easily question the clinical relevance of the statistically significant benefit of 34 seconds.Whatever the results of this study however, the proposed method to position, monitor, and reposition a DLT in the tracheal view using the VivaSight DLT is inadequate for a thoracic anesthesia provider. It might be easier and faster to place the VivaSight DLT, but this approach cannot replace a complete flexible bronchoscopic evaluation of subcarinal anatomy. A thoracic anesthesiologist should be an expert in bronchoscopic examination and use it as needed to enhance the safety of clinical outcomes. Safe and effective L-DLT positioning should include a distal examination of the bronchial extremity of the L-DLT to confirm an unobstructed view of the left upper and lower bronchial orifices and rule out any obstruction at this level. A deeper position may be used to minimize herniation of the bronchial cuff at the carinal level. 2,3 This approach increases the importance of monitoring the bronchial environment distal to the bronchial lumen, which cannot be achieved with the use of the VivaSight DLT.Conflicts of interest None declared.

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Correct positioning of double-lumen tubes

Cited by 5 publications

References 11 publications

Déflation du poumon non ventilé pendant la ventilation unipulmonaire avec un tube endotrachéal à double lumière : une étude randomisée contrôlée d’occlusion de la lumière endobronchique du poumon non ventilé avant l’ouverture pleurale

Déflation du poumon non ventilé pendant la ventilation unipulmonaire avec un tube endotrachéal à double lumière : une étude randomisée contrôlée d’occlusion de la lumière endobronchique du poumon non ventilé avant l’ouverture pleurale

Comparison between Displacement of PVC and Silicone DoubleLumen Endobronchial Tube during Lateral Positioning

Safe and effective positioning of a left-sided double-lumen tube

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