Choosing the Correct-Sized Adult Double-Lumen Tube: Quest for the Holy Grail

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ABSTRACT

Appropriate size selection of double-lumen tubes (DLTs) for one-lung ventilation (OLV) in adults is still a humongous task. Several important factors are to be considered like patient height, gender, tracheal diameter, left main bronchial diameter, and cricoid cartilage transverse diameter. In addition to radiological assessment of the airway diameters, the manufacturing details of the particular DLT being used also play a significant role in size selection. Optimal positioning of the appropriately sized DLT is indispensable to avoid complications like airway trauma, cuff rupture, hypoxemia, and tube displacement. It is imperative to know whether the one-size-fits-all dictum holds for DLT size selection as claimed by certain studies. Further randomized studies are required for crystallizing standard protocols ascertaining the correct DLT size. This systematic review article highlights the various parameters employed for DLT size selection and explores the newer DLTs used for adult OLV.

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Most cited references 39

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

Medhat Hannallah, Jonathan L. Benumof, Paul Silverman … (1997)

Evaluation of an approach to choosing left double-lumen tube size based on chest computed tomographic (CT) scan measurement of left bronchial diameter.

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Can ultrasound be useful for predicting the size of a left double-lumen bronchial tube? Tracheal width as measured by ultrasonography versus computed tomography.

Alan Šustić, A Ivancic, Tedi Cicvarić … (2008)

To correlate tracheal width as measured by ultrasound with width measured by computed tomography (CT), and to evaluate the possible role of ultrasound in the selection of the proper size of left-sided double-lumen endotracheal tubes (LDLTs). Two independent, prospective, observational clinical studies (Study 1 and Study 2). University hospital. Study 1 included 25 patients and Study 2 included 20 adult thoracic surgery patients who required a LDLT during anesthesia. In Study 1, CT measurements of tracheal width were made at the coronary plane 0.5 cm above the sternoclavicular joint; CT measurements of the left main bronchus diameter were made 1 cm below the carina. Ultrasound measurement of tracheal width was performed just above the sternoclavicular joint in the transversal section. In Study 2, patients' tracheas were intubated with a LDLT based on ultrasound measurements. The frequencies of incorrect selections of LDLT and unsatisfactory lung collapse were analyzed. There was a strong correlation between tracheal width as measured by ultrasound and tracheal width (r=0.882, P<0.001) and left main bronchus width (r=0.832, P<0.001) as measured by CT. In 5 cases (25%), the incorrect LDLT by ultrasound was selected; and one (5%) was found to have an unsatisfactory lung collapse. Measurement of the outer tracheal width by ultrasound can be a useful method for predicting the diameter of left main bronchus and for selecting a LDLT.

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Tracheal diameter predicts double-lumen tube size: a method for selecting left double-lumen tubes.

Routbort Mark, A Macario, J Brodsky (1996)

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Author and article information

Journal

Journal ID (nlm-ta): Ann Card Anaesth

Journal ID (iso-abbrev): Ann Card Anaesth

Journal ID (publisher-id): ACA

Journal ID (publisher-id): Ann Card Anaesth

Title: Annals of Cardiac Anaesthesia

Publisher: Wolters Kluwer - Medknow (India )

ISSN (Print): 0971-9784

ISSN (Electronic): 0974-5181

Publication date (Print): Apr-Jun 2023

Publication date (Electronic): 03 April 2023

Volume: 26

Issue: 2

Pages: 124-132

Affiliations

[1]Department of Anaesthesia and Critical Care, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India

[1 ]Department of Anaesthesiology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, CHS, New Delhi, India

Author notes

Address for correspondence: Dr. Shagun Bhatia Shah, H.No: 174,175 Ground Floor, Pocket 17, Sector 24 Rohini – 110 085, New Delhi, India. E-mail: drshagun_2010@ 123456rediffmail.com

Article

Publisher ID: ACA-26-124

DOI: 10.4103/aca.aca_140_22

PMC ID: 10284481

PubMed ID: 37706375

SO-VID: 32cdc280-ea5e-4806-a26d-bbece2a1e765

License:

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

History

Date received : 15 August 2022

Date revision received : 03 October 2022

Date accepted : 12 October 2022

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