Article

Brodsky JB, Lemmens HJ. Tracheal width and left double-lumen tube size: a formula to estimate left-bronchial width

Department of Anesthesia, Stanford University School of Medicine, Stanford, CA 94305, USA.
Journal of Clinical Anesthesia (Impact Factor: 1.21). 07/2005; 17(4):267-70. DOI: 10.1016/j.jclinane.2004.07.008
Source: PubMed

ABSTRACT To determine which patient parameters best predict left bronchial width (LBW) when selecting the correct size double-lumen tube (DLT). If LBW is known, a DLT that will fit that bronchus can be chosen.
Prospective study.
University medical center.
Three hundred twenty-one consecutive patients scheduled for thoracic surgery and for whom there was a chest radiograph and for whom tracheal width (TW) and LBW could be measured.
Tracheal width and LBW were directly measured from the chest radiograph. Patient demographic data were recorded and then analyzed to see which factor(s) best predicted LBW. Parameters often used for DLT selection (age, sex, height, and weight) as well as TW were compared by univariate and multivariate statistical analysis to see which factor(s) most accurately predicted LBW.
There were weak but significant correlations between age and height and LBW in men, and height and LBW in women. Multivariate statistical analysis showed that, for both men and women, TW was the best predictor of LBW. Sex, height, and weight did not improve predictability over TW alone. The equation that best predicts LBW for both sexes is: LBWmm = (0.50)(TWmm) + 3.7 mm. This model explains 46% of the variance in LBW. As structures measured from a chest radiograph are magnified by 10%, the formula to predict LBW, which normalizes for this magnification factor, is: LBWmm = (0.45)(TWmm(CXR)) + 3.3 mm.
Direct airway measurement is the most accurate way to select an appropriate DLT. However, when direct measurement of LBW cannot be performed, estimating LBW from TW is a better predictor of LBW than either sex, height, or weight.

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    • "radiography or using an ultrasound are superior methods of selecting an appropriately sized double lumen tube [4] [5]. Traditional teaching has used height as the major correlation with correct sizing of the double lumen tube. "
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