Modified right-sided Broncho-Cath™ double lumen tube improves endobronchial positioning: a randomized study

Bussières, Jean S.; Lacasse, Yves; Côté, Dany; Beauvais, Michel; St-Onge, Sophie; Lemieux, J M; Soucy, Julie

doi:10.1007/bf03022772

Cited by 23 publications

(19 citation statements)

References 21 publications

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“…The position of the tube was adjusted by an experienced anaesthetist, again guided by bronchoscopy. The right upper lobe ventilation slot was located and its distal edge was aligned with the distal margin of the right upper lobe orifice . The position of the bronchial cuff at the level of the carina after injection of 2–3 ml of air was then recorded.…”

Section: Methodsmentioning

confidence: 99%

The distance between the carina and the distal margin of the right upper lobe orifice measured by computerised tomography as a guide to right‐sided double‐lumen endobronchial tube use

et al. 2013

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The distance between the carina and the distal margin of the right upper lobe orifice measured by computerised tomography as a guide to right-sided double-lumen endobronchial tube use SummaryOur hypothesis was that the incidence of malposition of a right-sided double-lumen endobronchial tube and right upper lobe collapse may increase when the distance between the carina and the distal margin of the right upper lobe orifice is less than 23 mm, measured from a computerised tomography scan. A total of 76 patients undergoing leftsided thoracic surgery were enrolled. Patients with a measured distance of < 23 mm (n = 38) were compared with age-, sex-and body mass index-matched patients with a distance ! 23 mm (n = 38). Right-sided double-lumen endobronchial tubes were used universally. We monitored endobronchial tube malposition and incidence of right upper lobe collapse throughout surgery. There was a significantly higher incidence of bronchial cuff herniation in patients with a distance < 23 mm in both the supine position and the lateral decubitus position (p < 0.001). The incidence of intra-operative malposition in the < 23 mm group was also significantly higher than in the ! 23 mm group (31 (82%) vs 8 (21%), respectively, p < 0.001). Right upper lobe collapse was detected postoperatively in five patients (13%) in the distance < 23 mm group, compared to none in the ! 23 mm group. We recommend that the distance between the carina and the distal margin of the right upper lobe bronchus should be routinely measured on the pre-operative computerised tomography scan, and if it is < 23 mm, consideration should be given to using a left-sided endobronchial double-lumen tube in preference to a right-sided one.

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Section: Methodsmentioning

confidence: 99%

The distance between the carina and the distal margin of the right upper lobe orifice measured by computerised tomography as a guide to right‐sided double‐lumen endobronchial tube use

et al. 2013

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“…It seems to us that many other important aspects of lung isolation were omitted from this review, including some studies on alternative lung isolation devices and double lumen endotracheal tubes (DL-ETTs) 2,3 and some of our own work to improve the use of left and right DL-ETTs. 4 For example, in 2001, we published a randomized study challenging the classic technique 5 of positioning left-sided DL-ETTs and proposed a new position and landmark technique based on directly visualizing the carina through the left endobronchial lumen of the DL-ETT. 6 This technique involves inserting the blue bronchial cuff of the left DLT more deeply into the left mainstem bronchus.…”

Section: The Evidence Base Surrounding Lung Isolation Often Is Wider mentioning

confidence: 99%

Coronary Artery Bypass Grafting Using an Arteriovenous I-Conduit: Benefits and Drawbacks

Benussi

Gatti

Belgrano

et al. 2018

Journal of Cardiothoracic and Vascular Anesthesia

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We read with great interest the review article Lung Isolation for Thoracic Surgery: From Inception to Evidence-Based by Faulzon et al 1 in the Journal. Although we particularly appreciated the history and anatomy sections, we were somewhat disappointed by the sections describing the different techniques that have been used for lung isolation. It seems to us that many other important aspects of lung isolation were omitted from this review, including some studies on alternative lung isolation devices and double lumen endotracheal tubes (DL-ETTs) 2,3 and some of our own work to improve the use of left and right DL-ETTs. 6 This technique involves inserting the blue bronchial cuff of the left DLT more deeply into the left mainstem bronchus. Flexible bronchoscopy through the transparent wall of the left endobronchial lumen allows for the position of the DL-ETT to be adjusted so that the carina lies midway between the black radiopaque line and the top of the endobronchial cuff. The results showed a reduced need for repositioning of the DL-ETT after lateral positioning of the patient compared with the classic technique (16% v 43%, p ¼ 0.007).In summary, this technique reduces the need to reposition the left DLT and also potentially decreases the risk of tracheal laceration 7-9 and thus can contribute to more optimal one lung ventilation. We raise this issue to increase awareness that there is a wide evidence base for optimizing the efficacy and the safety of lung isolation techniques, some of which was omitted in this review.

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“…15,16 Malheureusement, ces efforts n'ont eu que très peu d'échos chez les fabricants de sondes commerciales. Vraisemblablement, le marché des SDL droites est trop restreint pour justifier les dépenses liées à une modification majeure approuvée par les organismes gouvernementaux de réglementation.…”

Section: L'utilisation Clinique Des Sondes à Double Lumière Droitesunclassified

“…15,16 Unfortunately, this effort has largely been met with inertia from the commercial tube manufacturers. Presumably, the right DLT market is too small to justify the expense of having a major modification approved by the governmental regulating agencies.…”

mentioning

confidence: 99%

The clinical use of right-sided double-lumen tubes

Slinger

2010

Can J Anesth/J Can Anesth

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Right-sided double-lumen tubes (DLTs) have a bad reputation. Many experts in the field of thoracic anesthesia regard them as being difficult to position, having a small margin of safety for correct placement, and being prone to intraoperative malpositioning. 1 However, in a randomized prospective study, Campos et al. compared the use of right vs left DLTs in two groups of 20 patients having left thoracotomies. 2 In this small study, there were no significant differences between the two types of DLTs with respect to the relevant aspects of clinical performance, including the time for left lung collapse and the incidence of inadvertent right upper lobe collapse. There was a tendency for rightsided tubes to become malpositioned intraoperatively, but in all cases this difficulty was corrected easily by fibreoptic bronchoscopy. In a more recent retrospective report, the anesthetic records of 961 thoracic procedures were examined at one teaching institution where the usual practice was to use a DLT contralateral to the side of surgery, i.e., a rightsided tube for left-sided surgery. 3 There were no differences in the incidences of hypoxemia, hypercarbia, or high airway pressures between patients managed with left or right DLTs. The current sales of DLTs in North America show a 10:1 preference for left-vs right-sided tubes (personal communication with Covidien, Mansfield, MA, USA), suggesting that the majority of anesthesiologists tend to use left DLTs whenever possible. Given the evidence that right DLTs may function as well as left DLTs, and in view of the fact that it is necessary to use a right DLT in certain select cases, 4 perhaps it is time to reconsider their use for routine airway management in thoracic surgery.To appreciate our current clinical practice in thoracic anesthesia, it is useful to understand how we arrived at where we are today. Both the spectrum of patients and the equipment available for lung isolation have changed drastically from the origins of lung isolation in the 1930s. At that time, thoracic surgery was essentially for complications of infectious diseases, e.g., abscesses, bronchiectasis, hemoptysis, etc., which were often due to tuberculosis. The anesthesiologist's major priority was to protect the dependent lung from contamination with the infected secretions from the operative lung. The initial methods of lung isolation involved placement of a modified endotracheal tube as a single-lumen endobronchial tube in the mainstem bronchus of the non-operative lung. These tubes were placed by a rigid bronchoscope through the singlelumen tube and rigid bronchoscopy was a standard skill of the pioneers of thoracic anesthesia. 5 Selective intubation of the contralateral lung became an established principle. In 1949, Carlens, a respirologist, introduced a red rubber leftsided DLT designed to be placed with topical anesthesia in awake patients with tuberculosis who were having splitlung broncho-spirometry as a part of their workup for possible lung resection. 6 This DLT was quickly adopted by the tho...

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Modified right-sided Broncho-Cath™ double lumen tube improves endobronchial positioning: a randomized study

Cited by 23 publications

References 21 publications

The distance between the carina and the distal margin of the right upper lobe orifice measured by computerised tomography as a guide to right‐sided double‐lumen endobronchial tube use

The distance between the carina and the distal margin of the right upper lobe orifice measured by computerised tomography as a guide to right‐sided double‐lumen endobronchial tube use

Coronary Artery Bypass Grafting Using an Arteriovenous I-Conduit: Benefits and Drawbacks

The clinical use of right-sided double-lumen tubes

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