Misplacement of left-sided double-lumen tubes into the right mainstem bronchus: incidence, risk factors and blind repositioning techniques

BMC Anesthesiology

Jae-Hyon Bahk¹  Yunseok Jeon¹  Deok Man Hong¹  Hyun Joo Kim²  Jun-Yeol Bae¹  Jeong-Hwa Seo¹ 

[1]Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu 03080, Seoul, South Korea

[2]Department of Anesthesiology and Pain Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu 120-752, Seoul, South Korea

关键词: One-lung ventilation;    Intubation, Intratracheal;    Bronchi;    Anesthesia, General;    Airway management;   

Others  :  1230286
DOI  :  10.1186/s12871-015-0138-1

 received in 2015-07-19, accepted in 2015-10-22,  发布年份 2015

【 摘 要 】

Background

Double-lumen endobronchial tubes (DLTs) are commonly advanced into the mainstem bronchus either blindly or by fiberoptic bronchoscopic guidance. However, blind advancement may result in misplacement of left-sided DLTs into the right bronchus. Therefore, incidence, risk factors, and blind repositioning techniques for right bronchial misplacement of left-sided DLTs were investigated.

Methods

This was an observational cohort study performed on the data depository consecutively collected from patients who underwent intubation of left-sided DLTs for 2 years. Patients’ clinical and anatomical characteristics were analyzed to investigate risk factors for DLT misplacements with logistic regression analysis. Moreover, when DLTs were misplaced into the right bronchus, the bronchial tube was withdrawn into the trachea and blindly readvanced without rotation, or with 90° or 180° counterclockwise rotation while the patient’s head was turned right.

Results

DLTs were inadvertently advanced into the right bronchus in 48 of 1135 (4.2 %) patients. DLT misplacements occurred more frequently in females, in patients of short stature or with narrow trachea and bronchi, and when small-sized DLTs were used. All of these factors were significantly inter-correlated each other (P < 0.001). In 40 of the 48 (83.3 %) patients, blind repositioning was successful.

Conclusions

Smaller left-sided DLTs were more frequently misplaced into the right mainstem bronchus than larger DLTs. Moreover, we were usually able to reposition the misplaced DLTs into the left bronchus by using the blind techniques.

Trial registration

ClinicalTrials.gov Identifier: NCT01371773.

【 授权许可】

   
2015 Seo et al.

【 图 表 】

Fig. 1.

Fig. 2.

Fig. 3.

【 参考文献 】

• [1]Benumof JL, Partridge BL, Salvatierra C, Keating J. Margin of safety in positioning modern double-lumen endotracheal tubes. Anesthesiology. 1987; 67:729-38.
• [2]Boucek CD, Landreneau R, Freeman JA, Strollo D, Bircher NG. A comparison of techniques for placement of double-lumen endobronchial tubes. J Clin Anesth. 1998; 10:557-60.
• [3]Hampton T, Armstrong S, Russell WJ. Estimating the diameter of the left main bronchus. Anaesth Intensive Care. 2000; 28:540-2.
• [4]Neustein SM, Eisenkraft JB. Proper lateralization of left-sided double-lumen tubes. Anesthesiology. 1989; 71:996.
• [5]Kim J, Lim T, Bahk JH. Tracheal laceration during intubation of a double-lumen tube and intraoperative fiberoptic bronchoscopic evaluation through an LMA in the lateral position -A case report. Korean J Anesthesiol. 2011; 60:285-9.
• [6]Seo JH, Kwon TK, Jeon Y, Hong DM, Kim HJ, Bahk JH. Comparison of techniques for double-lumen endobronchial intubation: 90 degrees or 180 degrees rotation during advancement through the glottis. Br J Anaesth. 2013; 111:812-7.
• [7]Seo JH, Hong DM, Lee JM, Chung EJ, Bahk JH. Double-lumen tube placement with the patient in the supine position without a headrest minimizes displacement during lateral positioning. Can J Anaesth. 2012; 59:437-41.
• [8]Jeon Y, Ryu HG, Bahk JH, Jung CW, Goo JM. A new technique to determine the size of double-lumen endobronchial tubes by the two perpendicularly measured bronchial diameters. Anaesth Intensive Care. 2005; 33:59-63.
• [9]Kim JH, Park SH, Han SH, Nahm FS, Jung CK, Kim KM. The distance between the carina and the distal margin of the right upper lobe orifice measured by computerised tomography as a guide to right-sided double-lumen endobronchial tube use. Anaesthesia. 2013; 68:700-5.
• [10]Chow MY, Liam BL, Thng CH, Chong BK. Predicting the size of a double-lumen endobronchial tube using computed tomographic scan measurements of the left main bronchus diameter. Anesth Analg. 1999; 88:302-5.
• [11]Brodsky JB, Shulman MS, Mark JB. Malposition of left-sided double-lumen endobronchial tubes. Anesthesiology. 1985; 62:667-9.
• [12]Lieberman D, Littleford J, Horan T, Unruh H. Placement of left double-lumen endobronchial tubes with or without a stylet. Can J Anaesth. 1996; 43:238-42.
• [13]Kubota H, Kubota Y, Toyoda Y, Ishida H, Asada A, Matsuura H. Selective blind endobronchial intubation in children and adults. Anesthesiology. 1987; 67:587-9.
• [14]Slinger PD, Campos JH. Chapter 66. Anesthesia for thoracic surgery. Miller’s Anesthesia. 8th ed. Miller RD, editor. Elsevier, Philadelphia; 1958.
• [15]Brodsky JB, Lemmens HJ. Left double-lumen tubes: clinical experience with 1,170 patients. J Cardiothorac Vasc Anesth. 2003; 17:289-98.