Tracheobronchial Trauma From Double-Lumen Tube Placement in Patients Undergoing Lung Transplantation

Abstract

DOUBLE-LUMEN endotracheal intubation is a widely accepted procedure performed to achieve lung isolation. It is used most commonly to facilitate exposure during thoracic surgery. Although the procedure is safe, it can result in rare but serious tracheobronchial injury. Systematic reviews have summarized the risk factors and suggested preventive measures, 1 Fitzmaurice BG Brodsky JB. Airway rupture from double-lumen tubes. J Cardiothorac Vasc Anesth. 1999; 13: 322-329 Google Scholar ,2 Liu S Mao Y Qiu P et al. Airway rupture caused by double-lumen tubes: A review of 187 cases. Anesth Analg. 2020; 131: 1485-1490 Google Scholar but the special considerations for double-lumen tube (DLT) placement in the lung transplant population have not been discussed. Here the authors present two case reports of tracheal injury in patients undergoing bilateral lung transplantation and discuss the increased risk for tracheal injury in this patient population. They make additional suggestions to increase the margin of safety of DLT placement and present the variation in bronchial lumen size among three manufacturers of DLTs commonly used in practice, with implications for DLT size selection.