The Effect of Fiberoptic Bronchoscopy-guided Technique for Placement of a Left-sided Double-lumen Tube on the Intubation Performance Compared with the Conventional Method Using a Macintosh Laryngoscope

Jung A Lim,Sung Hye Byun,In-Young Kim

doi:10.2174/2589645802014010115

Abstract

Background: The accurate placement of the double-lumen endotracheal tube is imperative for effective one-lung ventilation in thoracic surgery. Malpositioning and repositioning of a misplaced tube may cause excessive trauma. Objective: We hypothesized that the fiberoptic bronchoscope-guided method for double-lumen endotracheal tube placement would reduce the incidence of malpositioning as compared to the conventional method using the Macintosh laryngoscope. Methods: Fifty patients scheduled to undergo elective thoracic surgery were recruited and randomly assigned to the fiberoptic bronchoscope-guided [n=25; Group F] and conventional [n=25; Group C] method groups, according to the method of double-lumen endotracheal tube placement. The primary outcome was the incidence of double-lumen endotracheal tube malpositioning observed under the fiberoptic bronchoscope after initial placement. Secondary outcomes included the times for placement, confirmation, and total procedure of double-lumen endotracheal tube intubation. Results: The incidence of malpositioning after initial double-lumen endotracheal tube placement was significantly lower in Group F than in Group C (20.0% vs 68.0%). In addition, the time for placement was significantly higher in Group F than in Group C, and that for confirmation was significantly lower in Group F than in Group C. Conclusion: The fiberoptic bronchoscope-guided method for double-lumen endotracheal tube placement can reduce the incidence of malpositioning after initial placement and expedite the intubation process with a double-lumen endotracheal tube in thoracic surgery.

Highlights

Proper placement of a left-sided Double-Lumen endotracheal Tube (DLT) within the Left Mainstem Bronchus (LMB) is imperative for appropriate tube functioning and allows the operative lung to collapse while providing excellent visualization of the surgical field for thoracic surgeons [1, 2].previous papers reported a relatively high incidence of DLT misplacement (32%-83%) immediately after blind intubation [3 - 5]
The fiberoptic bronchoscope-guided method for double-lumen endotracheal tube placement can reduce the incidence of malpositioning after initial placement and expedite the intubation process with a double-lumen endotracheal tube in thoracic surgery
With respect to the primary outcome, the incidence of DLT malpositioning just after tube placement was significantly lower in the Group F than in the Group C (20.0% [5/25] vs. 68.0% [15/25], odds ratio [95% confidence interval]: 0.118 [0.032–0.428]; p=0.001; Table 2)

Summary

Introduction

Proper placement of a left-sided Double-Lumen endotracheal Tube (DLT) within the Left Mainstem Bronchus (LMB) is imperative for appropriate tube functioning and allows the operative lung to collapse while providing excellent visualization of the surgical field for thoracic surgeons [1, 2].previous papers reported a relatively high incidence of DLT misplacement (32%-83%) immediately after blind intubation [3 - 5]. Proper placement of a left-sided Double-Lumen endotracheal Tube (DLT) within the Left Mainstem Bronchus (LMB) is imperative for appropriate tube functioning and allows the operative lung to collapse while providing excellent visualization of the surgical field for thoracic surgeons [1, 2]. In addition to malpositioning per se, the repeated action of repositioning the misplaced tube could injure the airway, and increased manipulation of the DLT in the bronchus may lead to excessive trauma [5]. Several works focusing on DLT intubation have reported the usefulness of various Videolaryngoscope (VL) types compared with Macintosh laryngoscope [10 - 12]. A recent meta-analysis reviewing these studies showed that VL has unfavorable results compared to Macintosh laryngoscope in terms of DLT malpositioning incidence. Malpositioning and repositioning of a misplaced tube may cause excessive trauma

Methods

Results

Discussion

Conclusion