Morphometric indicators for selection of dual endobronchial tube in thoracic anesthesiology

Abstract

For the purpose of single-lung ventilation, various methods of lung isolation are used in the world, which is a prerequisite for many thoracic, cardiac and esophageal surgeries. Numerous studies have reported various methods for determining the optimal suitability between the diameter of the tube and the diameter of the left main bronchus for adequate ventilation and gas exchange during operations on the thoracic cavity. However, there is no consensus among anesthesiologists on the choice of tube size for effective lung ventilation and isolation. We have developed a new mathematical formula for determining the appropriate size of the left bilateral luminal endobronchial tube (LDT). The aim of the study was to determine the effectiveness of the developed standardized mathematical formula for determining the appropriate size of LDT for use in thoracic anesthesiology. The study was performed on 192 patients with diseases of the thoracic cavity (esophagus, lungs, mediastinum), operated on in the thoracoabdominal department of the Shalimov National Institute of Surgery and Tranplantology. A retrospective comparison group – 96 patients after thoracic surgery, which used the choice of LDT size according to the well-known Slinger method “according to the patient’s height”. The study group consisted of 96 patients after thoracic surgery, in which the choice of the size of the bifurcated endobronchial tube was used according to the developed method (according to the formula that evaluates morphometric indicators of height, sex and diameter of the left main bronchus). The application of the proposed method reduces (p = 0.001) the risk of pulmonary complications, HR = 0.39 (95 % CI 0.22-0.70) compared to traditional methods. The risk decreased 2.5 times.