Abstract
BackgroundA right-sided double-lumen tube (R-DLT) tends to obstruct the right upper lobe intraoperatively due to anatomical distortion during surgery. If the R-DLT is poorly matched with the patient’s airway anatomy, it will not be possible to correctly replace the tube with a fiberoptic bronchoscope (FOB). In our study, we aimed to explore an efficient method for difficult repositioning caused by right upper lobe occlusion during surgery: repositioning the R-DLT from the right main bronchus into the left main bronchus. The current study was designed to assess the efficacy and safety of this method.MethodsSixty adult patients scheduled to undergo left-sided thoracic surgery were randomly assigned to two groups. With the patient in the right lateral position during surgery, the R-DLT was pulled back to the trachea while being rotated 90° clockwise; it was then either rotated 90° clockwise for placement into the left main bronchus (Group L) or rotated 90° anticlockwise and returned to the right main bronchus (Group R) using FOB guidance. The primary outcomes included clinical performance, which was measured by intubation time, and the quality of lung collapse. A secondary outcome was safety, which was determined according to bronchial injury and vocal cord injury.ResultsThe median intubation time (IQR [range]) required for placement of a R-DLT into the left main bronchus was shorter than the time required for placement into the right main bronchus (15.0 s [IQR, 12.0 to 20.0 s]) vs 23.5 s [IQR, 14.5 to 65.8 s], P = 0.005). The groups showed comparable overall results for the quality of lung collapse during the total period of one-lung ventilation (P = 1.000). The numbers of patients with bronchial injuries or vocal cord injuries were also comparable between groups (Group R, 11/30 vs. Group L 8/30, P = 0.580 for bronchus injuries; Group R, 15/30 vs. Group L 13/30, P = 0.796 for vocal cord injuries).ConclusionsRepositioning a R-DLT from the right main bronchus into the left main bronchus had good clinical performance without causing additional injury. This may be an efficient method for the difficult repositioning of a R-DLT due to right upper lobe occlusion during surgery.Trial registrationChinese Clinical Trial Registry, ChiCTR-IPR-15006933, registered on 15 August 2015.
Highlights
A right-sided double-lumen tube (R-DLT) tends to obstruct the right upper lobe intraoperatively due to anatomical distortion during surgery
A R-DLT has a tendency to become malpositioned intraoperatively [6] due to anatomical distortion that may occur during lateral positioning of the patient [7]
For the second tracheal intubation in the lateral decubitus position, placement of the R-DLT into the left bronchus required a median duration of 15.0 s (IQR, 12.0 to 20.0 s), and placement of the R-DLT to the right bronchia required a median duration of 23.5 s (IQR, 14.5 to 65.8 s) (P = 0.005)
Summary
A right-sided double-lumen tube (R-DLT) tends to obstruct the right upper lobe intraoperatively due to anatomical distortion during surgery. If a R-DLT is poorly matched with the anatomy of the patient’s airway, it will not be possible to replace the R-DLT correctly using a fiberoptic bronchoscope (FOB) even with repeated attempts, and multiple attempts to replace a R-DLT can lead to severe airway injury. These problems can be corrected by exchanging a R-DLT with a L-DLT or by using an endobronchial blocker, exchanging a DLT with the patient in the lateral position is difficult and risks losing access to the airway
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