scholarly journals The combination of computed tomography measurements and flexible video bronchoscope guidance for accurate placement of the right-sided double-lumen tube: a randomized controlled trial

2020 ◽  
Author(s):  
Yongheng Hou ◽  
Huayue Liu ◽  
Wencheng Shi ◽  
Hengjing Zhao ◽  
Ke Peng ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Main Bronchus ◽  
Controlled Trial ◽  
Fiberoptic Bronchoscopy ◽  
Double Lumen Tube ◽  
Control Group ◽  
Trial Registry ◽  
Double Lumen ◽  
Lumen Tube ◽  
The Right

Abstract Background: Accurate placement of the right-sided double-lumen tube (RDLT) is still challenging. This study aims to explore the feasibility and accuracy of a modified intubation strategy by using a combination of computed tomography measurements and flexible video bronchoscope guidance.Methods: 108 adults requiring an RDLT for lung isolation were randomly allocated to 2 groups. Conventional fiberoptic bronchoscopy-guided technique was used in the control group. The following specifications applied to the modification group. Firstly, the length of the right main bronchus (RMB-L) and the anteroposterior diameter of RMB were measured in preoperative spiral computed tomography to predict the side and size of the tube; Then, a depth marker was made on RUSCH tube according to the difference between the RMB-L and the length of bronchia cuff (12 mm); Under the guidance of flexible video bronchoscope, the depth marker should be paralleled with the tracheal carina, and a characteristic white line on the tube should be paralleled with the secondary carina.Results: Compared with the control group, our modified strategy significantly increased the optimal plus acceptable position rate (76% vs. 98%, respectively; P < 0.039), decreased tube replacement rate (80% vs. 94%; P = 0.042), shortened the intubation time (101.4 ± 7.3 vs. 75.2 ± 8.1 seconds; P = 0.019), and had a lower incidence of transient hypoxemia (25% vs. 6%; P = 0.022), subglottic resistance (20% vs. 6%; P = 0.037), tracheobronchial injury (35% vs. 13; P = 0.037), and postoperative right upper lobe collapse (15% vs. 2%; P = 0.059).Conclusion: These data suggest the superiority of our modified technique compared to the conventional method for RDLT positioning.Trial registration: Chinese Clinical Trial Registry, ChiCTR1900021676, registered on 5 March 2019. URL of trial registry: http://www.chictr.org.cn/showprojen.aspx?proj=33189

scholarly journals Iatrogenic Left Main Bronchus Injury following Atraumatic Double Lumen Endotracheal Tube Placement

2013 ◽  
Vol 2013 ◽  
pp. 1-3
Author(s):  
William R. Hartman ◽  
Michael Brown ◽  
James Hannon
Keyword(s):  
Endotracheal Tube ◽  
Main Bronchus ◽  
Left Main Bronchus ◽  
Double Lumen Tube ◽  
Tube Placement ◽  
Left Main ◽  
Double Lumen ◽  
Lumen Tube ◽  
Double Lumen Endotracheal Tube ◽  
Endotracheal Tube Placement

Tracheobronchial disruption is an uncommon but severe complication of double lumen endotracheal tube placement. The physical properties of a double lumen tube (large external diameter and length) make tracheobronchial injury more common than that associated with smaller single lumen endotracheal tubes. Here we present the case of an iatrogenic left main bronchus injury caused by placement of a double lumen tube in an otherwise unremarkable airway.

scholarly journals Difficulty Intubating a Double-Lumen Tube due to a Tracheal Bronchus: A Case Report

2021 ◽  
Author(s):  
Wenzhu Wang ◽  
Ji Li ◽  
Jian Liu ◽  
Chengwei Song ◽  
ya-nan Zhang
Keyword(s):  
Left Lung ◽  
Lung Ventilation ◽  
Double Lumen Tube ◽  
Bronchial Blocker ◽  
Tracheal Bronchus ◽  
One Lung Ventilation ◽  
Double Lumen ◽  
Lumen Tube ◽  
The One ◽  
The Right

Abstract Background: Intubation difficulties, hypoxemia, inability to perform a one-lung ventilation, and high airway pressure often occur during double-lumen tube intubation. Tracheal bronchus is a very rare and difficult to find reason. We present a case of tracheal bronchus accidentally discovered during double-lumen tube intubation in a patient undergoing thoracic surgery. We are the first one to summarize the one-lung ventilation strategy for patients with tracheal bronchus. Case Presentation: A 53-year-old man underwent a scheduled thoracoscopic left upper lobectomy. After two unsuccessful attempts to pass the right-sided double-lumen tube through the right mainstem bronchus, fiberoptic bronchoscopy revealed an aberrant tracheal bronchus with an incidence of 0.1%–3%. Finally we used a left-sided DLT to ventilate the right lung. The patient had no airway complications and was discharged 7 days after the operation.Conclusions: This case serves to remind us that preoperative visits must be thorough and careful. Although a computed tomography chest examination was performed before surgery, we just looked at the inspection report and did not look at the images. We also reviewed relevant literature and summarized the one-lung ventilation strategies for patients with tracheal bronchus. For left-lung ventilation, either a left-sided double-lumen tube or a combination of a bronchial blocker and Fogarty artery embolization catheter can be used. For right-lung ventilation, a bronchial blocker or a left-sided double-lumen tube is a good choice.

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