Insertion Of Double-lumen Endotracheal Tube Research Articles

Bronchial Injury Following a Double-lumen Endotracheal Tube Insertion – How We Managed

Tracheobronchial injury is a known complication during a double-lumen tube intubation. There are several factors which increase the risk of such injuries, including malignancy, postirradiation and pulmonary tuberculosis. Here, we discuss a case of a female patient, diagnosed with adenocarcinoma of the lower lobe of the left lung, posted for lobectomy, who developed a left main bronchus injury during intubation with a double-lumen tube. We discuss the possible factors for the injury and how we managed it using a covered endobronchial stent.

Role of Lung Ultrasound in Confirmation of Double Lumen Endotracheal Tube Placement for Thoracic Surgeries: A Prospective Diagnostic Accuracy Study.

In thoracic surgeries requiring thoracotomy incisions, correct positioning of the double-lumen endotracheal tube (DLT) is mandatory. After the pandemic of novel COVID-19, using simple, noninvasive technology such as lung ultrasound (LUS) can be important in avoiding the possibility of spreading infectious diseases or contagious infections that can follow using fiberoptic bronchoscopy (FOB). We aimed to assess the accuracy of auscultation and LUS in relation to FOB in the assessment of DLT placement and to identify the possibility of using LUS as an alternative to FOB during DLT insertion. This diagnostic accuracy study was conducted according to STARD guidelines; enrolled 120 cases requiring DLT intubation. After DLT insertion, all patients were examined by stethoscope, then by LUS for determination of DLT position, and then confirmed by FOB in the same patient. Three patients dropped out due to failed intubation, and only 117 cases were analyzed. Time was significantly longer for LUS than for auscultation and FOB and was insignificantly different between auscultation and FOB. Auscultation had 76.14% sensitivity, 34.48% specificity, and 65.81% accuracy in the determination of correct DLT placement. LUS had 92.05% sensitivity, 79.31% specificity, and 88.89% accuracy in detecting correct DLT placement. There was substantial agreement between LUS and FOB (κ = 0.705) and poor agreement between auscultation and FOB (κ = 0.104). LUS can be used as a simple, noninvasive tool for detecting DLT placement with a substantial agreement with FOB.

GlideScope\xae versus C-MAC\xae(D) videolaryngoscope versus Macintosh laryngoscope for double lumen endotracheal intubation in patients with predicted normal airways: a randomized, controlled, prospective trial

BackgroundThe double lumen endotracheal tube (DLT) is the most widely-used device for single lung ventilation in current thoracic anesthesia practice. In recent years, the routine application of the videolaryngoscope for single lumen endotracheal intubation has increased; nevertheless there are few studies of the use of the videolaryngoscope for DLT. We wondered whether there were benefits to using the videolaryngoscope for DLT placement in patients with predicted normal airways. Therefore, this study was designed to compare the performances of the GlideScope®, the C-MAC®(D) videolaryngoscope and the Macintosh laryngoscope in DLT intubation.MethodsThis was a randomized, controlled, prospective study. We randomly allocated 90 adult patients with predicted normal airways into three groups. All patients underwent routine anesthesia using different laryngoscopes according to group allocation. We compared DLT insertion times, first-pass success rates, numerical rating scales (NRS) of DLT delivery and DLT insertion, Cormack-Lehane degrees (C/L), hemodynamic changes and incidences of intubation complications. All outcomes were analyzed using SPSS13.0.ResultsCompared with the GlideScope, the Macintosh gave shorter times for DLT insertion (median: 96 (IQR: 51 [min–max: 62–376] s vs 73 (26 [48–419] s, p = 0.003); however, there was no difference between the Macintosh and C-MAC(D) (p = 0.610). The Macintosh had a significantly higher successful first attempt rate than did the GlideScope or C-MAC(D) (p = 0.001, p = 0.028, respectively). NRS of DLT delivery and insertion were significantly lower in the Macintosh than in the others (p < 0.001). However, the C/L degree in the Macintosh was significantly higher than in the others (p < 0.001). The incidences of oral bleeding, hoarseness, sore throat and dental trauma were low in all groups (p > 0.05). There were no significant differences in DLT misplacement, fiberoptic time or hemodynamic changes among the groups.ConclusionsCompared with the Macintosh laryngoscope, the GlideScope® and C-MAC®(D) videolaryngoscopes may not be recommended as the first choice for routine DLT intubation in patients with predicted normal airways.Trial registrationThe study was prospectively registered at the Chinese Clinical Trial Registry (no. ChiCTR1900025718); principal investigator: Z.L.H.; date of registration: September 6, 2019.

Movements of the double-lumen endotracheal tube due to lateral position with head rotation and tube fixation: a Thiel-embalmed cadaver study.

Following successful double-lumen endotracheal tube (DLT) insertion for pulmonary surgery, the body position of a patient is changed from supine to lateral. This change occasionally leads to the malposition of the DLT and difficulty in differential lung ventilation. In this study, we investigated movements of the DLT induced by change in body position from supine to lateral, using Thiel-embalmed cadavers. Thiel-embalmed cadavers retain full flexibility of the body and preservation of natural colours, using novel preservation techniques. After the tip of the DLT was directly fixed with forceps at the appropriate position in the bronchus, the DLT depth was measured at the lip in supine and lateral positions. The depth of DLT insertion measured at the lip in right (25.2 ± 0.3 cm; mean ± SEM) and left (25.1 ± 0.3 cm) lateral positions was significantly increased compared to the supine position (24.7 ± 0.3 cm). We recommend that the depth of DLT insertion should be advanced by approximately 0.5 cm from the best position, before changing from the supine to lateral position.

Clinical experiences with a new endobronchial blocking device: the EZ-Blocker

Both elective and emergency thoracic surgical procedures may require one-lung ventilation (OLV) for lung isolation [1]. Although in the majority of the cases a double lumen endotracheal tube (DLT) is the first choice, there are situations when insertion of DLT is not feasible [2]. We therefore intended to test the applicability of a recently developed endobronchial blocker (BB), the EZ-Blocker, in clinical practice.