Predicting the Size of a Double-Lumen Endobronchial Tube Using Computed Tomographic Scan Measurements of the Left Main Bronchus Diameter

Chow, Mark Y. H.; Liam, B. L.; Thng, Choon-Hua; Chong, Bee Kiang

doi:10.1097/00000539-199902000-00014

Cited by 30 publications

(35 citation statements)

References 10 publications

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“…In fact, this strictly resembles Porwolik’s findings [19] in slowing growth dynamics of the two main bronchi. In this study, the statistical analysis showed that the left main bronchus was nearly three times longer than the right one, in keeping with other authors [2, 4, 12, 15, 16, 18–20, 25]. Furthermore, the present study has confirmed that with relation to each other, the main bronchi evolve proportionately in length.…”

Section: Discussionsupporting

confidence: 92%

“…This necessitates an extensive knowledge of fetal airway biometric parameters for particular gestational weeks to further determine pathological criteria adapted to fetal and neonatal tracheobronchial anatomy [19, 24]. Furthermore, the appropriate size of a double-lumen tube for one-lung anesthesia depends on the internal diameter of the mainstem bronchus, in which the bronchial segment of the tube is to be inserted [2, 4, 7, 8, 10, 11]. …”

Section: Introductionmentioning

confidence: 99%

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Novel patterns for the growing main bronchi in the human fetus: an anatomical, digital and statistical study

et al. 2013

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PurposeIntensive progress in prenatal medicine results in performing airway management in the fetus affected by life-threatening congenital malformations. This study aimed to examine age-specific reference intervals and growth dynamics for length, proximal and distal external transverse diameters, and projection surface areas of the two main bronchi at varying gestational ages, including their relative growth in length and projection surface area.Materials and methodsUsing anatomical dissection, digital image analysis and statistics, length, proximal and distal external transverse diameters, and projection surface areas of the right and left main bronchi were examined in 73 human fetuses (39 males, 34 females) aged 14–25 weeks, derived from spontaneous abortions and stillbirths.ResultsStatistical analysis showed no sex differences. Between the 14 and 25th week of gestation, the lengths of the right and left main bronchi increased from 1.43 ± 0.18 to 3.18 ± 0.39 mm, and from 2.97 ± 0.16 to 7.58 ± 1.95 mm, in accordance with the functions: , respectively. The proximal external transverse diameters of the right and left main bronchi varied from 2.13 ± 0.41 to 4.24 ± 0.20 mm, and from 1.84 ± 0.06 to 3.67 ± 0.66 mm, following the logarithmic models: , respectively. The distal external transverse diameter rose from 2.09 ± 0.47 to 4.24 ± 0.20 mm, as for the right main bronchus, and from 1.85 ± 0.04 to 3.67 ± 0.66 mm, like for the left one. On either side, there were no statistically significant differences between values of the proximal and distal transverse diameters of the main bronchus. The projection surface areas of the right and left main bronchi ranged from 2.95 ± 0.19 to 13.34 ± 2.12 mm2, and from 5.57 ± 0.21 to 28.52 ± 5.24 mm2, as and . The two main bronchi revealed a proportionate increase in both length and projection surface area, since the right-to-left bronchial length ratio and the right-to-left bronchial projection surface area ratio were stable, 0.41 ± 0.07 and 0.47 ± 0.08, respectively, throughout the analyzed period.ConclusionsThe main bronchi show no sex differences. The right and left main bronchi grow logarithmically in length and external transverse diameter, and linearly in projection surface area. The right and left main bronchi evolve proportionately, with the right-to-left bronchial ratios of 0.41 ± 0.07 for length, and 0.47 ± 0.08 for projection surface area.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Novel patterns for the growing main bronchi in the human fetus: an anatomical, digital and statistical study

et al. 2013

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“…Another report showed that tracheas were successfully intubated in 18 Asian women after selecting left DLT sizes based on CT scans. [6] Smaller sizes were required in 2% (6/300) of American adult patients because of the greater difficulty of insertion into the left mainstem bronchus than in the glottis. [7] In the current study, difficulty in passage through smaller cricoid cartilages occurred in seven patients (2.5%, 7/280).…”

Section: Discussionmentioning

confidence: 99%

“…[7] In 8 of 32 short Asian women (height, <152 cm), a left DLT <32-Fr in size (8.7 mm outer diameter of the bronchial lumen, Broncho-Cath™; Mallinckrodt, St. Louis, MO, USA) was needed. [6] Moreover, left DLTs <35-Fr (9.6 mm, Broncho-Cath™) in size were needed in 27 of 48 women with heights of 152–160 cm. [8] According to Miller's Anaesthesia, a reputed textbook, the bronchial diameter should be examined and a 32-Fr DLT should be considered for short-statured female patients (<152 cm); the DLT should be able to pass the glottis without resistance.…”

Section: Discussionmentioning

confidence: 99%

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Difficulty in inserting left double-lumen endobronchial tubes at the cricoid level in small-statured women: A retrospective study

Sato

Kayashima

2017

Indian J Anaesth

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Background and Aims:Left double-lumen endobronchial tube (DLT) sizes are selected using tracheal diameters and left mainstem bronchial diameters (LMBDs) determined from chest radiographs or computed tomography (CT) scans. In Western women, 35-Fr or 37-Fr DLTs are often selected. However, difficulties can be encountered when inserting 32-Fr or 35-Fr DLTs in Japanese women. We investigated success rates for 32-Fr or 35-Fr DLT insertion in Japanese women and determined the causes of unsuccessful DLT insertion.Methods:We searched anaesthesia records of Japanese women aged ≥20 years who underwent thoracic surgery with 32-Fr or 35-Fr DLTs between April 2010 and March 2015 in our hospital. In the successful group (SG), patients were intubated using the initially selected DLTs. By contrast, in the unsuccessful group (UG), the DLT size had to be changed. The Mann–Whitney U-test and Fisher's exact test were used to compare groups.Results:The SG included 149 (96.1%) of 155 cases of 32-Fr DLT use and 119 (95.2%) of 125 cases of 35-Fr DLT use. Patient height was significantly lower in the UG than in the SG for the 35-Fr DLT (P = 0.0036). In seven of 12 UG patients (three for 32-Fr and four for 35-Fr), the transverse diameters of cricoid cartilages were smaller than the DLTs' tracheal diameters, thereby preventing passage through the cricoid cartilages.Conclusion:Along with LMBDs, transverse diameters of cricoid cartilages based on CT scans or ultrasonogram findings may help in selecting the appropriate left DLT size.

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Anestesia ed Analgesia Postoperatoria in Chirurgia Toracica Videoassistita

Indrizzi

Magni

Tassi

Chirurgia Toracica Videoassistita

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Predicting the Size of a Double-Lumen Endobronchial Tube Using Computed Tomographic Scan Measurements of the Left Main Bronchus Diameter

Abstract: We used computer tomographic scans to measure the diameter of the left mainstem bronchus, then selected the size of the left-sided double-lumen endobronchial tube (DLT) accordingly. We found that we could predict the sizes of the DLT fairly accurately, especially the smaller DLTs.

Cited by 30 publications

References 10 publications

Novel patterns for the growing main bronchi in the human fetus: an anatomical, digital and statistical study

Novel patterns for the growing main bronchi in the human fetus: an anatomical, digital and statistical study

Difficulty in inserting left double-lumen endobronchial tubes at the cricoid level in small-statured women: A retrospective study

Anestesia ed Analgesia Postoperatoria in Chirurgia Toracica Videoassistita

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