Brodsky JB, Lemmens HJ. Tracheal width and left double-lumen tube size: a formula to estimate left-bronchial width
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.
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.
- SourceAvailable from: agialpress.com
02/2015; 3. DOI:10.11131/2015/101133
- "radiography or using an ultrasound are superior methods of selecting an appropriately sized double lumen tube  . Traditional teaching has used height as the major correlation with correct sizing of the double lumen tube. "
- [Show abstract] [Hide abstract]
ABSTRACT: Recent advances in surgical techniques for thoracic, cardiac, and oesophageal surgery have led to an increased use of lung separation techniques. Currently, double-lumen endotracheal tubes (DLT) and bronchial blockers (an Arndt wire-guided endobronchial blocker, a Cohen Flexitip endobronchial blocker, or the Fuji Uniblocker) are used. 1-3 Achieving successful lung separation relies on knowledge of the anatomical distances of the airway, flexible fibreoptic bronchoscopy techniques, and familiarity with left and right-sided DLTs and bronchial blockers. In general, lung isolation techniques are designed to: facilitate surgical exposure for cases involving the thoracic cavity, to prevent contamination of the contralateral lung in cases where pus or haemorrhage is present, and to establish airway continuity such as in a patient who presents with bronchopleural fistula and requires mechanical ventilation. Specific indications with bronchial blockers include: patients with difficult airways, patients with tracheostomy that require lung separation, selective lobar blockade, or whenever postoperative mechanical ventilation is contemplated. This review focuses on the current methods used to achieve lung separation. The objectives include: selecting the proper size device, intubation issues, optimal positioning with the use of a flexible fibreoptic bronchoscope, potential complications, and the management of lung isolation devices and what to do when they do not work.08/2014; 14(1). DOI:10.1080/22201173.2008.10872517
- [Show abstract] [Hide abstract]
ABSTRACT: This review considers the anesthetic management of obese patients undergoing thoracic surgery. Extremely or morbidly obese patients differ from patients of normal weight in several ways. Obese patients have altered anatomy and physiology, and usually have associated comorbid medical conditions that may complicate their operative course and increase their risks for postoperative complications. During anesthetic induction and laryngoscopy for tracheal intubation the morbidly obese patient should be in the reverse Trendelenburg position with the head and neck elevated above the table. Placement of a double-lumen tube should be no more difficult in an obese patient than in a normal-weight patient. There are no clear advantages for any of the commonly available inhalational anesthetic agents and each can be used for general anesthesia. With proper attention to their special needs, the morbidly obese patient can safely undergo thoracic surgery and one-lung ventilation.Current Opinion in Anaesthesiology 03/2007; 20(1):10-4. DOI:10.1097/ACO.0b013e32800ff73c · 1.98 Impact Factor