A quality improvement study of the placement and complications of double-lumen endobronchial tubes

Abstract

To assess the complications of conventional and fiberoptic endobronchial intubations using reusable (Leyland, London) and disposable (Rusch, Waiblinger, Germany; Sheridan, Argyle, NY) double-lumen tubes (DLTs), endobronchial intubations occurring over a 12-month period were prospectively studied at this hospital. Residents working with staff anesthesiologists placed either left or right reusable (Leyland) or disposable (Rüsch or Sheridan) DLTs. The DLT used, the use of fiberoptic bronchoscopy (FOB), findings at FOB if used during the intubation or operation, and complications occurring during the case (SpO 2 < 90%, peak inflation pressure > 40 cm H 2O, air trapping, poor lung isolation, and airway trauma) were recorded. Two hundred thirty-four intubations were analyzed (102 right, 132 left; 70 Leyland reusable DLTs, 66 Rusch disposable tubes, and 98 Sheridan tubes). Physical signs alone were used to confirm tube position more frequently when Leyland tubes were placed compared with disposable tubes (79% v 39%, P < 0.0001). Rüsch and Sheridan DLTs had similar rates of conventional placement. Nineteen percent of reusable tubes and 44% of disposable tubes required position adjustments using FOB during the initial intubation ( P = 0.0002). Disposable tubes also more commonly required readjustment using FOB during the operation (30% v 7%, P < 0.0005). Complications occurred in 42 234 patients (18%). The frequency of specific complications was: decreased SpO 2, 9%; increased airway pressures, 9%; poor lung isolation, 7%; air trapping, 2%, and airway trauma, 0.4%. Right-sided Sheridan DLTs had a statistically higher incidence of malposition, resulting in poorer lung isolation. The frequency of specific complications was otherwise not correlated with the type of DLT chosen, the side intubated, or the use of FOB during intubation. FOB was useful in confirming or adjusting DLT position when complications occurred during OLV.