Double lumen tube location predicts tube malposition and hypoxaemia during one lung ventilation

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Poor positioning of an endobronchial double lumen tube (DLT) could affect oxygenation during one lung ventilation (OLV). We set out to relate DLT position to hypoxaemia and DLT misplacement during OLV. We recruited 152 ASA physical status I-II patients about to have elective thoracic surgery. The trachea was intubated with a left-sided DLT. Tube position was assessed by fibre-optic scope and correction was made after patient positioning and during OLV. If Pa(O(2)) was less than 10.7 kPa, the DLT position was checked and then PEEP, continuous positive airway pressure (CPAP), oxygen insufflation, or two lung ventilation (TLV) were tried. The DLT was found to be misplaced in 49 patients (32%) after patient positioning, and in 38 patients (25%) during OLV. PEEP to the dependent lung, CPAP or apneic oxygen insufflation to the non-dependent lung, or brief periods of TLV, were applied in 46 patients (30%). Patients who had DLT malposition after placing the patient in the lateral position had a greater incidence of DLT malposition during OLV (59 vs 9%) and also required each intervention more frequently (57 vs 10%). Patients with DLT malposition during OLV also required interventions more often (84 vs 12%). Patients who have DLT malposition after placing the patient in the lateral position had more DLT malposition during OLV and hypoxaemia during OLV.