Bronchial Cuff Research Articles

The Degree of Bronchial Mucosal Damages Related to the Bronchial Blocker Cuff Pressure of Univent(R) Tube

The Degree of Bronchial Mucosal Damages Related to the Bronchial Blocker Cuff Pressure of Univent(R) Tube

Airway troubles related to the double-lumen endobronchial tube in thoracic surgery.

Several case reports indicate critical respiratory complications in relation to the double-lumen endobronchial tube (DLT). A prospective survey for the airway problems in using the DLT is presented. One hundred adult patients undergoing thoracotomy for lung cancer were investigated. Tube malposition and airway obstruction were searched using a fiber-optic scope. The endobronchial cuff was positioned just below the trachcal carina while the trachea was intubated with a DLT (Rüsch). The distances of displacement, from the tracheal carina to the bronchial cuff, were measured during anesthesia using an epidural catheter, which had marks every 5 mm. The distances for correcting the tube position were measured at both the bronchial cuff and the level of the teethPaO2,PaCO2 andSPO2 were also measured. Malposition (displacement over 5 mm from the correct position) was found in 42 patients, and 40 of them were in a withdrawal direction, occurring at the postural change and during one-lung ventilation, especially during manipulation of the lung hilum. Correcting distances at the level of the teeth were 15.3-3-times longer than those at the bronchial cuff. Airway deformities and gradual withdrawal of the bronchial cuff were found in association with surgical manipulation. Obstruction occurred at the tips of the tracheal tube in four patients and the bronchial tube in six patients, and at the tip of both in two patients. Hypoxemia (PaO2<60 mmHg) occurred in four patients and hypercapnea (PaCO2>60 mm Hg) in two patients. Most of the DLT obstructions were associated with withdrawal malposition. Great attention to DLT displacement and airway deformity is advised.

A comparison of two different bronchial cuff designs and four different bronchial cuff inflation methods

Objective: To compare directly measured pressures at the cuff/trachea interface that are associated with two different bronchial cuff designs and four different methods of bronchial cuff inflation suggested for use with one-lung ventilation. Design: In vitro study. Setting: Experimental laboratory in a university-affiliated hospital. Interventions: The bronchial cuffs of two different endotracheal tubes were inflated using one of four different methods of determining the cuff volume and pressure necessary to “just seal” the bronchus and obtain lung separation: positive-pressure test, negative-pressure test, CO 2 analysis, and a new test using an anesthesia ventilator. When each method predicted the “just-seal” state, the pressure at the cuff/bronchus interface as well as cuff inflation pressure and volume were recorded. Measurements and Main Results: Although the new test was incompatible with the bronchial blocker, the other three tests all accurately predicted lung separation with the Univent, with no significant differences in pressures exerted on the trachea. However, when used with the double-lumen tube, the new test produced significantly lower measured parameters than the other inflation methods. CO 2 analysis did not reliably predict bronchial seal with the double-lumen tube. Conclusions: To achieve lung separation with the lowest pressure on the trachea, the new test is the most appropriate method for use with the double-lumen tube; however, the negative-pressure test appeared to be the easiest and fastest method for use with the bronchial blocker. Although the bronchial blocker was associated with lower pressures transmitted from the cuff to the trachea, the in vitro model cannot predict which bronchial cuff design would be superior in vivo.

Displacement of the Double-Lumen Endobronchial Tube Can Be Detected by Bronchial Cuff Pressure Change

We measured the bronchial cuff pressure of left-sided double-lumen endobronchial tubes (DLTs) in 54 patients to confirm the effect of DLT displacement on cuff pressure. After positioning the cephalad surface of the bronchial cuff of the DLT 2.5 cm distal to the carina (23 patients in the first part of the study) or just below the carina (23 patients in the second part), the cuff was withdrawn in 0.5-cm steps during right-sided, onelung ventilation. The bronchial cuff pressure was measured, and the capnogram and pressure-volume loop, displayed by a side-stream spirometer, was evaluated. After positioning the cephalad surface of the bronchial cuff just below the carina (eight patients in the third part), bronchial cuff pressure was measured while confirming the position of the bronchial cuff during the 30 min of the operative procedure. The bronchial cuff pressure decreased significantly by 28.4 cm H2 O (P < 0.01) and 21.3 cm H2 O (P < 0.01) in the first and second parts, respectively, before the pressure-volume loop or the capnogram changed. The bronchial cuff pressure in the third part showed no significant change. We conclude that bronchial cuff pressure monitoring was very helpful in detecting displacement of the DLT during right-sided, one-lung ventilation. (Anesth Analg 1997;84:1349-53)

Evaluation of an approach to choosing a left double-lumen tube size based on chest computed tomographic scan measurement of left mainstem bronchial diameter

Objective: Evaluation of an approach to choosing left double-lumen tube size based on chest computed tomographic (CT) scan measurement of left bronchial diameter. Design: Prospective. Setting: The operating rooms of a university hospital. Participants: Patients scheduled for elective thoracic surgery. Interventions: Patients had their left bronchial diameter measured on the preoperative chest CT scan. Left doublelumen tube size for the individual patient was chosen from a protocol based on left bronchial diameter. Measurements and Main Results: The double-lumen tube size was considered appropriate for the patient if some air leak was detected when the bronchial cuff was deflated and if airtight seal of the left bronchus was obtained with a bronchial cuff volume of 2 mL or less. In 17 of 20 patients, the double-lumen tube size fulfilled both criteria. In 3 women with left bronchi measuring 10mm or less, the bronchus was sealed without any air in the bronchial cuff of size 35 Fr left double-lumen tubes. In 1 patient, who was excluded from the study, the double-lumen tube size was chosen based on measurement of the left bronchial diameter on chest radiograph because of motion artifact on the chest CT scan. Conclusions: Chest CT scan measurement of left bronchial diameter can successfully guide the choice of left doublelumen tube size for an individual patient. In individuals with a small left bronchus measuring less than 10.0 mm in diameter, currently available adult double-lumen tube sizes will tightly wedge in their bronchus.

A Study about the Bronchial Cuff Volume of the Left-sided Double-Lumen Endobronehial Tube

Background: In using the Double-lumen tube(DLT), knowing the minimum bronchial cuff volume (MCV) for an effective air-tight seal will be useful; to provide a collapse of the lung; and to avoid pressure damage. The aims of the present study are thus three-fold: to measure the MCV; to measure the diameter of left main bronchus(LMBD); and to prove any relationships between two parameters. Methods: One hundred men and forty women who needed intubation of left-sided DLT were enrolled in this study. 37 Fr DLTs were used in male patients, and 35 Fr DLTs were used in female patients. We evaluated the MCV by air bubble method and measured the LMBD in chest PA. We also evaluated the pressure/volume characteristics of the bronchial cuffs by control inflator. Results: 29 patients of 100 patients(29%) exhibited persistent air leakage in 2.5 ml cuff volume in male patients(group of MCV ＞2.5). On the contrary, 18 patients of 40 patients(45%) did not require any cuff volume in female patients(group of MCV 0). The mean LMBD were 13.23 1.45 mm in male and 11.09 0.96 mm in female. There were significant positive correlations between MCV and LMBD in both sex and their respective correlation coefficients were 0.264(P=0.008) in male and 0.484(P=0.002) in female. The equations of linear regression were: LMBD = 12.394 0.429×MCV in male, LMBD = 10.725 0.438×MCV in female. Conclusions: The MCV of the brochial cuffs in left-sided DLTs has significant relationships with the LMBD measured in chest PA. (Korean J Anesthesiol 1997; 33: 849∼857)

The Depth of Double Lumen Endobronchial Tube and the Effect of Lateral Decubitus Position to the Depth in Korean Adult Patients

Background : During one-lung anesthesia in thoracic surgery, accurate placement of double lumen endobronchial tube(DLT) is essential. We have only a few data regarding adequate depth of DLT, especially after position change. We measured the depth of DLT and the change of depth after position change in 50 adult patients. Methods : After endotracheal intubation with left-sided Robertshaw type polyvinyl chloride(PVC) endobronchial tube, fiberoptic bronchoscope was inserted through tracheal lumen and we positioned the proximal end of the bronchial cuff just below the carinal bifurcation. The depth of the DLT from the upper incisor was recorded, and was rechecked after position change to lateral position. Results : The depth of the DLT was 29.4 ±1.3 cm(male: 30.2± 0.9, female: 28.2± 0.8) and this was related with height. But in female group depth of DLT was not related with height. Within the same height group, the depth of DLT differ up to 3.5 cm. The change of depth more than 0.5 cm after position change ocurred in 21 out of 50 patients. Conclusion: The adequate depth of DLT in Korean patients, in total patients and in male group seems to related with their height, but in female group the depth of DLT was not related with their height. Within same height group, the depth of DLT may differ greatly. So, the depth of DLT must be adjusted individually. After position change, the head and neck should be kept in neutral position and the adequacy of the depth of DLT must be rechecked. (Korean J Anesthesiol 1997; 32: 390∼396)

A comparison of the endobronchial segment of modern left-sided double-lumen tubes in anesthesia for bilateral sequential lung transplantation

To compare a range of currently available left-sided double-lumen endotracheal tubes (DLTs) in order to demonstrate differences among them with respect to the length of the endobronchial segment. It is proposed that a tube with a short endobronchial segment is better suited to anesthesia under the conditions imposed by double sequential lung transplantation. A university hospital with a large heart and lung transplant unit. The DLTs included in the study were Sher-I-Bronch (Sheridan of Kendall Australia, North Ryde, Sydney, Australia); BronchoCath and BronchoCath II (Mallinckrodt Medical, St Louis, MO); Rüsch single use (Rüsch, Wailbilngen, Germany); Portex single use (Portex, Keen, NH); and Phoenix single-use Robertshaw (Promedica, Preston, Lancashire, UK). The endobronchial segment was measured as the distance from the point of inflation of the bronchial cuff to the tip of the tube. This distance was measured for each manufactured brand in a range of tubes and the mean obtained. The DLTs were compared to assess variability within the brand, and the influence of size on the endobronchial segment. All brands were then compared. Variability within brands is consistent with manufacturer's specified range of +/- 1 to 3 mm. The endobronchial segment increases with size for Rusch and Phoenix DLTs as a design feature. The average lengths of the endobronchial segments are Rusch 23 +/- 2 mm (sizes 35/37) and 25 +/- 2 mm (sizes 39/41); Mallinckrodt 30 +/- 3 mm (BronchoCath) and 31 +/- 3 mm (BronchoCath II); Portex 35 +/- 2 mm; Sheridan 35 +/- 2 mm; Phoenix 47 mm (small), 52 mm (medium), and 56 mm (large). There exists marked variability in the length of the endobronchial segment of left-sided double-lumen tubes currently available. These differences may be significant in anesthesia for bilateral sequential lung transplantation.

Bronchial Cuff Inflation Technique for Proper Positioning of Double-lumen Endobronchial Tube

Background: Accurate placement of double-lumen endobronchial tube(DLT) is essential for successful one-lung anesthesia. This study was performed to evaluate the effectiveness of bronchial cuff inflation technique for accurate placement of DLT. Methods: One hundred and five patients undergoing elective thoracotomy which required the use of DLTs were studied. Following induction of anesthesia, the tip of the left-sided DLT was advanced just past the vocal cords, the stylet in the endobronchial lumen was removed and the tube was rotated 90 degrees counterclockwise. After rotation of DLT, the bronchial cuff was inflated with air(4-6 ml) and the tube was advanced until resistance to further passage was encountered. After deflating of the bronchial cuff, the tube was advanced 2 cm more distally. The fiberoptic bronchoscopy was then introduced into the tracheal lumen of the tube and the tube's position was evaluated. Results: In the 100 patients out of 105 patients, the tube was inserted into the left side bronchus correctly. In the 77 patients(77 %) out of 100 patients, the position of DLTs was evaluated as ideally placed. In the l6 patients(16 %), the tube was evaluated as too deeply inserted into the appropriate bronchus and in the other 7 patients, the tube was too shallow. But only one patient needed repositioning. Conclusions: Bronchial cuff inflation technique may be useful for accurate placement of DLT for the one-lung anesthesia in the situation without fiberoptic bronchoscope. (Korean J Anesthesiol 1996; 31: 330-333)

Comparison of the Degree of Bronchial Mucosal Damage according to the Bronchial Cuff Pressure of Double Lumen Tubes

Comparison of the Degree of Bronchial Mucosal Damage according to the Bronchial Cuff Pressure of Double Lumen Tubes

Bronchial Cuff Volume of Univent Tube for One Lung Ventilation

Bronchial Cuff Volume of Univent Tube for One Lung Ventilation

Improvement of Arterial Oxygen Saturation with Selective Lobar Bronchial Block During Hemorrhage in a Patient with Previous Contralateral Lobectomy

Improvement of Arterial Oxygen Saturation with Selective Lobar Bronchial Block During Hemorrhage in a Patient with Previous Contralateral Lobectomy

Intentional Occlusion of the Right Upper Lobe Bronchial Orifice to Tamponade Life-threatening Hemoptysis

Intentional Occlusion of the Right Upper Lobe Bronchial Orifice to Tamponade Life-threatening Hemoptysis

Incidence of malposition of polyvinylchloride and red rubber left-sided double-lumen tubes and clinical sequelae

Currently, fiberoptic bronchoscopy (FB) is recommended for correct positioning of double-lumen endobronchial tubes (DLTs) because of the high incidence of malpositions not appreciated by clinical signs. The aims of this study were to assess whether clinical signs allow accurate confirmation of adequate positioning with left red rubber (RR) or polyvinyl-chloride (PVC) double-lumen tubes and to compare the incidence of malpositions between the two tubes. Another goal was to assess whether these malpositions, not appreciated by clinical assessment, adversely affected outcome. Twenty-one adult patients scheduled for elective thoracic surgery were randomly assigned to the RR (11 patients) or PVC group (10 patients). After endobronchial intubation, the position of the tubes was adjusted until clinically satisfactory lung separation had been achieved. A single investigator performed all the FB assessments were performed in the supine (SUP) and lateral positions. The anesthesiologists responsible for the clinical evaluation were "blinded" to the bronchoscopic findings. While in the SUP position, the tube was "too deep" to permit visualization of the carina during tracheal bronchoscopy in 5 patients (2 RR, 3 PVC). In 17 of 21 (10 RR, 7 PVC), the bronchial cuff could not be visualized, although in 1 patient (RR group), the cuff was overinflated and bulged out to partially obstruct the right main bronchus orifice. Bronchial bronchoscopy showed 4 of 11 patients in the RR group in whom the left upper lobe orifice was occluded compared with 1 only in the PVC group.(ABSTRACT TRUNCATED AT 250 WORDS)

Bronchial Cuff Sealing Volume of Left - sided Double - lumen Endobronchial Tube according to Bronchus Diameter and Tube Size in Man

Bronchial Cuff Sealing Volume of Left - sided Double - lumen Endobronchial Tube according to Bronchus Diameter and Tube Size in Man

Le tube Univent™ : un substitut aux tubes à double lumière

The Univent™ tube was designed as an alternative to double lumen endotracheal tubes. It is a conventional single lumen tube with an additional small channel within the concave anterior wall portion that houses a movable bronchial blocker used for lung isolation. A thin lumen in the blocker itself allows lung deflation and various ventilatory patterns (oxygen inflow, CPAP, jet-ventilation) in the blocked lung. Main indications for the Univent™ tube include difficult intubation, risk of aspiration and planned postoperative ventilation. The « blindinsertion of the bronchial balloon carries a high risk of primary malpositioning or secondary displacement that may cause a loss of the lung isolation or even tracheal obstruction. Initial insertion with fiberoptic bronchoscope is therefore required and this device must also be available during the whole period of one lung ventilation. High pressures generated by the bronchial cuff and higher cost than that of double lumen endotracheal tubes are two other factors that limit the use of the Univent™ tube.

The resting volume and compliance characteristics of the bronchial cuff of left polyvinyl chloride double-lumen endobronchial tubes.

The resting volume of a low-pressure, high-volume cuff is an important factor that determines the cuff compliance, because it is the maximum volume that maintains the low-pressure characteristics of the cuff. Modern polyvinyl chloride (PVC) double-lumen tubes (DLT) are designed with a low-pressure bronchial cuff to minimize the risk of bronchial damage. Maintenance of the low-pressure characteristics of this cuff, however, requires knowledge of how its resting volume and compliance vary between different DLT sizes and brands, and how the compliance changes when the cuff is inflated inside different-sized bronchi. We, therefore, measured the bronchial cuff pressure-volume relationship for each of the adult sizes, 35 Fr, 37 Fr, 39 Fr, and 41 Fr, of the Mallinckrodt, Sheridan, Rusch, and Portex left DLTs. The compliance of each cuff was characterized by: 1) the cuff resting volume, defined as the smallest cuff volume beyond which a 0.5-mL increase in volume resulted in more than 10 mm Hg increase in cuff pressure; and 2) the cuff pressure at 3-mL volume. Measurements were repeated for sizes 35 Fr and 41 Fr left Mallinckrodt DLTs with the bronchial cuff lying inside two canine left main-stem bronchi measuring 11 mm and 13 mm in diameter. The bronchial cuff resting volume ranged from 1.5 to 5.0 mL in different sizes and brands of DLTs, which could be explained by differences in cuff size between different manufacturers and between different DLT sizes of the same manufacturer.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of Three Techniques to Inflate the Bronchial Cuff of Left Polyvinylchloride Double-Lumen Tubes

Correct inflation of the cuff of any breathing tube is important; overinflation can damage the mucosa of the tracheobronchial tree and underinflation will cause a leak. Three different techniques to determine cuff seal/leak during inflation of the bronchial cuff of left double-lumen endobronchial tubes (DLT) were each evaluated in 10 patients. DLT size was chosen from a formula based on the patient's height and sex. In the first technique, designated the positive pressure technique of bronchial cuff inflation (PPT), the bronchial side of the DLT is pressurized during connection of the tracheal side to a beaker of water. Air bubbles will appear in the beaker in the absence of bronchial seal. The second technique, designated the CO2 analysis technique of bronchial cuff inflation (CAT), is based on analysis of CO2 content of gas sampled from the tracheal side of the DLT during ventilation of its bronchial side. When the bronchus is sealed, the normal CO2 waveform changes to a flat line. In the third technique, designated the negative pressure technique of bronchial cuff inflation (NPT), suction is applied to the tracheal side of the DLT. The absence of bronchial seal will result in collapse of the reservoir bag within a breathing system connected to the bronchial side of the tube. The bronchial sealing volumes were 1.1 +/- 0.9 mL, 0.9 +/- 0.7 mL, and 0.3 +/- 0.4 mL (mean +/- SD) when measured with the PPT, CAT, and NPT, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

A Clinical Comparison of Bronchial Cuff Pressures in Three Different Designs of Left Double-Lumen Tubes

A Clinical Comparison of Bronchial Cuff Pressures in Three Different Designs of Left Double-Lumen Tubes

A CASE OF TRACHEAL RUPTURE DUE TO DOUBLE-LUMEN TUBE

This paper describes a case of tracheal rupture due to a double-lumen tube with some notes on 6 cases of tracheobronchial rupture seen in the Japanese literature. A 63-year-old man underwent surgery for an esophageal carcinoma, when a 37Fr. Broncho-Cath® tube was intubated, and esophagectomy was made through a right thoracotomy. After resection of the esophagus, we noticed the herniation of a bronchial cuff through the tracheal tear. Surgical repair of the lesion was accomplished with a direct suture. Postoperative course was uneventful, because an endotracheal tube was detained at a peripheric trachea. All cases seen in the Japanese literature had uneventful postoperative course, however, a death case has been reported in the foreign literature. Double-lumen tube has been increasingly used mainly for the management of the airway during thoracic surgeries. In a use of double-lumen tube, well acquaintance with its characteristics would be mandatory.