Double-lumen tube placement with the patient in the supine position without a headrest minimizes displacement during lateral positioning

Abstract

Double-lumen tube placement with the patient in the supine position without a headrest minimizes displacement during lateral positioning La mise en place d'une sonde à double lumière chez un patient en decubitus dorsal sans appuie-tête minimise le risque de déplacement au cours du passage en decubitus latéral Abstract Purpose The correct position of double-lumen tubes (DLTs) is customarily confirmed after tracheal intubation by bronchoscopy with the patient supine on a headrest. However, displacement of DLTs usually occurs during lateral positioning because of neck extension. This study was undertaken to determine whether displacement of DLTs could be minimized during lateral positioning if DLTs were positioned without a headrest. Methods One hundred patients scheduled for thoracic surgery were randomized into two groups (n = 50 each). After tracheal intubation using a headrest, adjustment of DLT position was performed according to group assignment, i.e., either with the headrest in place or without the headrest. Using a bronchoscope, distances from the tracheal opening to the main carina and from the bronchial opening to the left bronchial carina were measured in both the supine and lateral positions. Results Displacement of DLTs [mean (standard deviation)] during lateral positioning was greater in the headrest group than in the no-headrest group [12.3 (6.5) mm vs 6.8 (5.5) mm, respectively, in the trachea; 11.6 (6.7) mm vs 6.0 (4.6) mm, respectively, in the bronchus; P \ 0.001]. The incidence of significant displacement, defined as [ 10 mm from initial correct position, was greater in the headrest group than in the no-headrest group (64% vs 28%, respectively, in the trachea; 58% vs 20%, respectively, in the bronchus; P \ 0.001). Conclusion Displacement of DLTs during lateral positioning appears to be caused primarily by extension of the neck. Correct adjustment of DLT position without a headrest in the supine position is an easy and effective method to minimize DLT displacement during lateral positioning (ClinicalTrials.gov number, NCT01413347). RésuméObjectif La bonne position des sondes a`doubles lumie`res (DLT) est d'ordinaire confirme´e par bronchoscopie apre`s intubation trache´ale chez un patient en decubitus dorsal avec appuie-teˆte. Cependant, ces sondes se de´placent habituellement au cours d'un changement de position en decubitus late´ral en raison d'une extension du cou. Cette e´tude a e´te´entreprise pour de´terminer si le de´placement des DLT pouvait eˆtre minimise´au cours d'un passage en This article is accompanied by an editorial, please see Can J Anesth 2012; 59: this issue.

The effects of thermal softening of double-lumen endobronchial tubes on postoperative sore throat, hoarseness and vocal cord injuries: a prospective double-blind randomized trial

“…9 If severe resistance was encountered at the glottis, the DLT was further rotated counterclockwise up to 180°directing the tracheal lumen anteriorly and its advancement through the glottis was attempted. 7 After removing the headrest, 8 the patient's head was placed in the neutral position, and the DLT position was correctly adjusted under fibreoptic bronchoscopy. If the DLT was misdirected into the right bronchus, it was repositioned into the left bronchus under fibreoptic bronchoscopic guidance.…”

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

“…BD. This result shows that gravity does not play an important role in DLT displacement [4,7]. Tracheal and bronchial displacement during lateral positioning are not constant, and changes in ΔTD and ΔBD do not differ significantly [7,10].…”

“…Neck movement is known to influence DLT position [3]. Therefore, methods to minimize neck movement during position changes are recommended [4]. Polyvinyl chloride (PVC) DLTs are hard, so, depending on the extent of neck movement, there may be significant DLT movement.…”

Feasibility of MDCT for Predicting Left Double Lumen Endotracheal Tube Displacement during Supine to Lateral Repositioning of Patients

“…This means that several factors, such as cervical extension and flexion, DLT size, tracheal deviation, lung collapse during differential ventilation, carinal displacement, and arcuation, may cause DLT displacement when the patient is moved from the supine to lateral position. Both neck extension and flexion cause movement of the DLT [17][18][19][20] . In our study, the VBS was measured under FOB and with a McGRATH MAC ® video laryngoscope with the patient in the supine position and neck extended over a pillow after intubation.…”