Abstract
To find the faster and easier way than the existing intubating technique for double-lumen tube, we modified the angle of double-lumen tube according to an individual’s upper airway anatomy and compared the time needed and the number of attempts for successful intubation between individually angle-modified and non-modified double-lumen tubes. Adult patients undergoing elective thoracic surgery were randomly allocated in either non-angle-modified (Group N, n = 54) or angle-modified (Group M, n = 54) groups. During mask ventilation in the sniffing position, angle-modification was performed in Group M as follows: the distal tip of the tube was placed at the level of the cricoid cartilage and the shaft was bent at the intersection of the oral and pharyngeal axes estimated from the patient’s surface anatomy. The time needed and the number of attempts for successful intubation and Cormack and Lehane (C-L) grade were recorded. Overall median intubation time (sec) was significantly shorter in Group M than in Group N [10.2 vs. 15.1, P<0.001]. In addition, Group M showed the shorter median intubation time (sec) in C-L grades I-III [8.2 vs. 11.1 in C-L grade I, (P = 0.003), 10.3 vs. 15.3 in II, (P = 0.001), and 11.8 vs. 27.9 in III, (P<0.001), respectively]. Moreover, all intubation was successfully performed at the first attempt in patients with C-L grades I-III in Group M (P = 0.027). Our study showed an individual angle-modification would be useful for the fast and easy intubation of double-lumen tube in patients with C-L grades I-III.Trial Registration: ClinicalTrials.gov NCT02190032
Highlights
During mask ventilation in the sniffing position, angle-modification was performed in Group M as follows: the distal tip of the tube was placed at the level of the cricoid cartilage and the shaft was bent at the intersection of the oral and pharyngeal axes estimated from the patient’s surface anatomy
All intubation was successfully performed at the first attempt in patients with Cormack and Lehane (C-L) grades I-III in Group M (P = 0.027)
Among the seven patients who required more than one intubation attempt, six were in group N and one was in group M (Table 2)
Summary
A double-lumen tube is more difficult to insert than a single-lumen tube mainly because of its wider external diameter, less compliant characteristics, and straighter shape, [1,2,3] it has been generally accepted as a standard technique for lung isolation during thoracic surgery. [1] various videolaryngoscopic devices, in spite of the successful achievement of PLOS ONE | DOI:10.1371/journal.pone.0161434 August 18, 2016Effects of Individually Angle-Modified Double-Lumen Tube better laryngeal views, have failed to show the superiority to the direct laryngoscopy for the faster placement of double-lumen tube. [3,4,5]Basically, tracheal intubation is composed of three sequential steps: 1) the achievement of laryngeal view, 2) the delivery of tube to the glottis, and 3) the advancement of tube into trachea. [6, 7] the ability to visualize the larynx might not be sufficient for the fast and successful intubation of a double-lumen tube. Effects of Individually Angle-Modified Double-Lumen Tube better laryngeal views, have failed to show the superiority to the direct laryngoscopy for the faster placement of double-lumen tube. Considering the distinguishing characteristics of double-lumen tube, accurate delivery of the tube to the glottis might be a crucial step, a good laryngeal view is a common important step for tracheal intubation. To our knowledge, the usefulness of angle-modification has never been studied for inserting double-lumen tube. We hypothesized that the individually angle-modified double-lumen tube is superior to the manufacturer-provided double-lumen tube with respect to the time and the number of attempts needed for successful intubation. The aim of this study was to evaluate the usefulness of individual angle-modification in patients requiring double-lumen tube intubation
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