Changes in the Bronchial Cuff Pressure of Left-Sided Double-Lumen Endotracheal Tube by Lateral Positioning: A Prospective Observational Study

Proper bronchial cuff pressure (BCP) is important when using a double-lumen endotracheal tube (DLT), especially in thoracic surgery. As positional change during endotracheal tube placement could alter cuff pressure, we aim to evaluate the change in BCP of DLT from the supine to the lateral decubitus position during thoracic surgery. A total of 69 patients aged 18–70 years who underwent elective lung surgery were recruited. BCP was measured at a series of time points in the supine and lateral decubitus positions after confirming the DLT placement. The primary outcome was change in the initial established BCP (BCPi), which is the maximum pressure at which the BCP did not exceed 40 cmH2O without air leak in the supine position, after lateral decubitus positioning. As the primary outcome, the BCPi increased from 25.4 ± 9.0 cmH2O in the supine position to 29.1 ± 12.2 cmH2O in the lateral decubitus position (p < 0.001). Out of the 69 participants, 43 and 26 patients underwent surgery in the left-lateral decubitus position (LLD group) and the right-lateral decubitus position (RLD group) respectively. In the LLD group, the BCPi increased significantly (p < 0.001) after lateral positioning and the beginning of surgery and the difference value, ∆BCPi, from supine to lateral position was significantly higher in the LLD group than in the RLD group (p = 0.034). Positional change from supine to lateral decubitus could increase the BCPi of DLT and the increase was significantly greater in LLD that in RLD.

Download Full-text

Effect of lateral positioning on the bronchial cuff pressure of a left-sided double-lumen endotracheal tube during thoracic surgery: study protocol for a prospective observational study

BMJ Open ◽

10.1136/bmjopen-2018-026606 ◽

2019 ◽

Vol 9 (3) ◽

pp. e026606

Author(s):

Eugene Kim ◽

In-Young Kim ◽

Sung-Hye Byun

Keyword(s):

Observational Study ◽

Thoracic Surgery ◽

Endotracheal Tube ◽

Cuff Pressure ◽

Air Leak ◽

Double Lumen ◽

Double Lumen Endotracheal Tube ◽

Bronchial Cuff ◽

Lateral Decubitus ◽

Lateral Positioning

IntroductionCorrect pressure is important when using a double-lumen endotracheal tube (DLT), especially in thoracic surgery. An inadequate bronchial cuff pressure (BCP) can cause air leak and interfere with visualisation of the surgical field, whereas an excessive pressure BCP can lead to cuff-related complications. Based on several reports that cuff pressure could alter after a positional change when using an endotracheal tube, we hypothesise that a change from the supine position to the lateral decubitus position, which is essential for thoracic surgery, would affect the BCP of the DLT.Methods and analysisThis prospective, single-centre, observational study will enrol 74 patients aged 18–70 years undergoing elective lung surgery from September 2018 to April 2019. The primary outcome will be the change in the ‘initially established BCP’ (maximum BCP not exceeding 40 cm H2O with no air leak in the supine position) after lateral decubitus positioning. BCP and air leak will be assessed in each patient position during inflation of the cuff with air in 0.5 mL increments from 0 to 3 mL. Secondary outcomes will include the incidence of BCP exceeding 40 cm H2O after the initial established value and that of a change in the smallest bronchial cuff volume without air leak after a change to the lateral position. The relationship between the change in BCP and airway pressure, compliance and body mass index after lateral positioning will be investigated.Ethics and disseminationThe study will be conducted in accordance with the Declaration of Helsinki and supervised by the Daegu Catholic University Medical Center institutional review board (study approval number CR-18–111). All patients will receive information about the study and will need to provide written informed consent before enrolment. The results will be presented at an international meeting and published in a peer-reviewed journal.Trial registration numberNCT03656406; Pre-results.

Download Full-text

The Effects of Endobronchial Cuff Inflation on Double Lumen Endotracheal Tube Movement After Lateral Decubitus Positioning

Anesthesia & Analgesia ◽

10.1213/00000539-199504001-00042 ◽

1995 ◽

Vol 80 (Supplement) ◽

pp. SCA43

Author(s):

D. P. Desiderio ◽

M. Burt ◽

A. C. Kolker ◽

M. E. Fischer ◽

R. Reinsel ◽

...

Keyword(s):

Endotracheal Tube ◽

Cuff Inflation ◽

Double Lumen ◽

Double Lumen Endotracheal Tube ◽

Lateral Decubitus ◽

Endobronchial Cuff

Download Full-text

Lung Separation during Thoracic Surgery: Arndt Endobronchial Blocker® Versus Double-Lumen Endotracheal Tube

Anesthesiology ◽

10.1097/00000542-200209002-01316 ◽

2002 ◽

Vol 96 (Sup 2) ◽

pp. A1316

Author(s):

Volker Lischke ◽

Stephan Mierdl ◽

Klaus Westphal ◽

Dirk Meininger ◽

Christian Byhahn

Keyword(s):

Thoracic Surgery ◽

Endotracheal Tube ◽

Double Lumen ◽

Double Lumen Endotracheal Tube ◽

Endobronchial Blocker

Download Full-text

Videolaryngoscopy versus direct laryngoscopy for double-lumen endotracheal tube intubation in thoracic surgery - a randomised controlled clinical trial

BMC Anesthesiology ◽

10.1186/s12871-020-01067-x ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Joachim Risse ◽

Ann-Kristin Schubert ◽

Thomas Wiesmann ◽

Ansgar Huelshoff ◽

David Stay ◽

...

Keyword(s):

Clinical Trial ◽

Thoracic Surgery ◽

Endotracheal Tube ◽

Direct Laryngoscopy ◽

Controlled Clinical Trial ◽

Double Lumen ◽

Double Lumen Endotracheal Tube ◽

Randomised Controlled Clinical Trial ◽

Randomised Controlled

Download Full-text

The Effect of Fiberoptic Bronchoscopy-guided Technique for Placement of a Left-sided Double-lumen Tube on the Intubation Performance Compared with the Conventional Method Using a Macintosh Laryngoscope

The Open Anesthesia Journal ◽

10.2174/2589645802014010115 ◽

2020 ◽

Vol 14 (1) ◽

pp. 115-122

Author(s):

Jung A. Lim ◽

In-Young Kim ◽

Sung Hye Byun

Keyword(s):

Thoracic Surgery ◽

Endotracheal Tube ◽

Conventional Method ◽

Macintosh Laryngoscope ◽

Tube Placement ◽

Fiberoptic Bronchoscope ◽

Double Lumen ◽

Double Lumen Endotracheal Tube ◽

Endotracheal Tube Placement ◽

Initial Placement

Background: The accurate placement of the double-lumen endotracheal tube is imperative for effective one-lung ventilation in thoracic surgery. Malpositioning and repositioning of a misplaced tube may cause excessive trauma. Objective: We hypothesized that the fiberoptic bronchoscope-guided method for double-lumen endotracheal tube placement would reduce the incidence of malpositioning as compared to the conventional method using the Macintosh laryngoscope. Methods: Fifty patients scheduled to undergo elective thoracic surgery were recruited and randomly assigned to the fiberoptic bronchoscope-guided [n=25; Group F] and conventional [n=25; Group C] method groups, according to the method of double-lumen endotracheal tube placement. The primary outcome was the incidence of double-lumen endotracheal tube malpositioning observed under the fiberoptic bronchoscope after initial placement. Secondary outcomes included the times for placement, confirmation, and total procedure of double-lumen endotracheal tube intubation. Results: The incidence of malpositioning after initial double-lumen endotracheal tube placement was significantly lower in Group F than in Group C (20.0% vs 68.0%). In addition, the time for placement was significantly higher in Group F than in Group C, and that for confirmation was significantly lower in Group F than in Group C. Conclusion: The fiberoptic bronchoscope-guided method for double-lumen endotracheal tube placement can reduce the incidence of malpositioning after initial placement and expedite the intubation process with a double-lumen endotracheal tube in thoracic surgery.

Download Full-text