Abstract
Proper bronchial cuff pressure (BCP) is important when using a double-lumen endotracheal tube (DLT), especially in thoracic surgery. As positional change during endotracheal tube placement could alter cuff pressure, we aim to evaluate the change in BCP of DLT from the supine to the lateral decubitus position during thoracic surgery. A total of 69 patients aged 18–70 years who underwent elective lung surgery were recruited. BCP was measured at a series of time points in the supine and lateral decubitus positions after confirming the DLT placement. The primary outcome was change in the initial established BCP (BCPi), which is the maximum pressure at which the BCP did not exceed 40 cmH2O without air leak in the supine position, after lateral decubitus positioning. As the primary outcome, the BCPi increased from 25.4 ± 9.0 cmH2O in the supine position to 29.1 ± 12.2 cmH2O in the lateral decubitus position (p < 0.001). Out of the 69 participants, 43 and 26 patients underwent surgery in the left-lateral decubitus position (LLD group) and the right-lateral decubitus position (RLD group) respectively. In the LLD group, the BCPi increased significantly (p < 0.001) after lateral positioning and the beginning of surgery and the difference value, ∆BCPi, from supine to lateral position was significantly higher in the LLD group than in the RLD group (p = 0.034). Positional change from supine to lateral decubitus could increase the BCPi of DLT and the increase was significantly greater in LLD that in RLD.
Highlights
Double-lumen endotracheal tubes (DLTs) are commonly used to create adequate one-lung ventilation (OLV) in thoracic surgery
Bronchial injuries, such as mucosal edema, have been reported in studies related to DLT [9]; it is necessary for clinicians to pay attention to the bronchial cuff pressure of the DLT in order to prevent the cuff-related complication
The present study showed that both bronchial cuff pressure (BCP) and peak inspiratory pressure (PIP) were significantly increased from supine to LLD position, but there was no significant correlation between the BCP and PIP
Summary
Double-lumen endotracheal tubes (DLTs) are commonly used to create adequate one-lung ventilation (OLV) in thoracic surgery. The bronchial cuff of the DLT should be placed in the proper position and inflated to an appropriate pressure, in order to achieve the perfect lung isolation [1]. Excessive pressure on the cuff of the DLT should be avoided to prevent cuff-related complications such as airway trauma [1], similar to those which can occur with single-lumen endotracheal tubes (ETT) [3,4,5,6,7]. Bronchial injuries, such as mucosal edema, have been reported in studies related to DLT [9]; it is necessary for clinicians to pay attention to the bronchial cuff pressure of the DLT in order to prevent the cuff-related complication. There is only limited literature on the proper range of bronchial cuff pressure (BCP), the initial BCP that can be used to create an effective seal to avoid air leakage around the cuff, while avoiding bronchial damage has been thought to be
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