Computed tomography-based tracheobronchial image reconstruction allows selection of the individually appropriate double-lumen tube size

Abstract

Objectives: To determine whether individualized selection of double-lumen tubes or alternatives based on three-dimensional reconstruction of the tracheobronchial image from routine preoperative computed tomography (CT) scans leads to clinically appropriate choices. Design: Prospective observational study; comparison to historic controls. Setting: Anesthesia and radiology facilities of a university medical center. Participants: Forty-nine patients undergoing thoracic surgery requiring one-lung ventilation. Interventions: Three-dimensional image reconstruction of individual tracheobronchial anatomy was performed from routine preoperative spiral CT scans as well as from scans of five left-sided and four right-sided double-lumen tubes. Results of image-based tube size selection were compared with literature recommendations. Prospectively, individualized tube selection was performed by superimposition of printed transparencies of tubes over the tracheobronchial system and was validated using bronchoscopic and clinical criteria (n = 24). Measurements and Main Results: Three-dimensional reconstruction visualized individual anatomy with good accuracy and resolution. Correlations between patient morphology and tracheobronchial dimensions were weak (height versus mainstem bronchial diameters: r < 0.50). In 11 of 48 patients (23%). CT-fitted double-lumen tube sizes would have differed from a conventional height-based and gender-based selection. Individual, prospective, CT-based double-lumen tube selection was associated with (1) good fit and positioning confirmed by fiberoptic bronchoscopy, (2) adequate bronchial cuff seal volumes, (3) complete lung separation, and (4) oxygenation and ventilation parameters during one-lung ventilation similar to those with conventional size selection. In one patient, three-dimensional CT study allowed noninvasive evaluation of a tracheal stenosis precluding double-lumen tube placement. Conclusion: Individualized selection of double-lumen tube size using CT-based reconstructions of tracheobronchial anatomy leads to clinically appropriate choices. Risks resulting from variations in tracheobronchial morphology are recognized in advance.