Misplacement of left-sided double-lumen tubes into the right mainstem bronchus: incidence, risk factors and blind repositioning techniques

Abstract

BackgroundDouble-lumen endobronchial tubes (DLTs) are commonly advanced into the mainstem bronchus either blindly or by fiberoptic bronchoscopic guidance. However, blind advancement may result in misplacement of left-sided DLTs into the right bronchus. Therefore, incidence, risk factors, and blind repositioning techniques for right bronchial misplacement of left-sided DLTs were investigated.MethodsThis was an observational cohort study performed on the data depository consecutively collected from patients who underwent intubation of left-sided DLTs for 2 years. Patients’ clinical and anatomical characteristics were analyzed to investigate risk factors for DLT misplacements with logistic regression analysis. Moreover, when DLTs were misplaced into the right bronchus, the bronchial tube was withdrawn into the trachea and blindly readvanced without rotation, or with 90° or 180° counterclockwise rotation while the patient’s head was turned right.ResultsDLTs were inadvertently advanced into the right bronchus in 48 of 1135 (4.2 %) patients. DLT misplacements occurred more frequently in females, in patients of short stature or with narrow trachea and bronchi, and when small-sized DLTs were used. All of these factors were significantly inter-correlated each other (P < 0.001). In 40 of the 48 (83.3 %) patients, blind repositioning was successful.ConclusionsSmaller left-sided DLTs were more frequently misplaced into the right mainstem bronchus than larger DLTs. Moreover, we were usually able to reposition the misplaced DLTs into the left bronchus by using the blind techniques.Trial registrationClinicalTrials.gov Identifier: NCT01371773.

McGrath Series 5 videolaryngoscope vs Airtraq DL videolaryngoscope for double-lumen tube intubation

“…[37] The risk factors included women, short stature, narrow tracheal and bronchial diameter, and small DLT. A previous study showed that the McGrath Series 5 increased the incidence of DLT malposition.…”

Augmentation of curved tip of left-sided double-lumen tubes to reduce right bronchial misplacement: A randomized controlled trial

“…Two investigators (SY, S-HM) measured the inner diameters of the left and right mainstem bronchi on the preoperative computed tomography. [16–19] The DLT size was selected based on the left bronchial diameter or sex and height of the patient. [4, 5, 16, 19]…”

“…A previous retrospective study suggested that the left-sided DLT with an obtuse tip angle was more likely to enter the right bronchus probably because the curved tip may not reach the left bronchial opening even after left rotation of the DLT. [16] We thus performed a prospective randomized trial comparing the right bronchial misplacement of left-sided DLTs with different tip angles. Our hypothesis was that the DLT with an acute tip angle enters the right bronchus less frequently than the tube with an obtuse tip angle.…”

Avoidable tracheal injury using a double-lumen endotracheal tube: a case report

“…Blind insertion of a DLT is a common technique; however, misplacement of a left DLT in the right mainstem bronchus was reported in 48 (4.2%) of 1,135 consecutive patients in a single centre study. 2 Subsequent manipulations of DLTs are another risk factor for tracheal trauma. 3 It is the authors' opinion that moving a DLT while the patient is in the lateral decubitus position is more difficult and traumatic and we suspect that was the mechanism of the injury described here.…”