Difference between revisions of "Double-lumen endotracheal tube"
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{{Infobox surgical case reference | {{Infobox surgical case reference | ||
| anesthesia_type = | | anesthesia_type = Thoracic anesthesia | ||
| airway = | | airway = | ||
| lines_access = | | lines_access = | ||
| monitors = | | monitors = | ||
| considerations_preoperative = | | considerations_preoperative = | ||
| considerations_intraoperative = | | considerations_intraoperative = Hypoxemia | ||
| considerations_postoperative = | Misplacement | ||
Inadvertent airway suturing | |||
Airway perforation | |||
| considerations_postoperative = Traumatic Laryngitis | |||
Vocal cord palsy | |||
Tracheal irritation | |||
}} | }} | ||
Provide a brief summary of this surgical procedure and its indications here. | Provide a brief summary of this surgical procedure and its indications here. | ||
== Indications == | == Indications<ref name=":0">{{Cite journal|last=Hao|first=David|last2=Saddawi-Konefka|first2=Daniel|last3=Low|first3=Sarah|last4=Alfille|first4=Paul|last5=Baker|first5=Keith|date=2021-10-14|editor-last=Ingelfinger|editor-first=Julie R.|title=Placement of a Double-Lumen Endotracheal Tube|url=http://www.nejm.org/doi/10.1056/NEJMvcm2026684|journal=New England Journal of Medicine|language=en|volume=385|issue=16|pages=e52|doi=10.1056/NEJMvcm2026684|issn=0028-4793}}</ref> == | ||
* Hemorrhage an infected abscess into a single lung requiring isolation | * Hemorrhage an infected abscess into a single lung requiring isolation | ||
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** Left pneumonectomy | ** Left pneumonectomy | ||
** Left lung transplant | ** Left lung transplant | ||
** Trauma to the left mainstem bronchus<ref name=":1">{{Cite journal|last=Pedoto|first=Alessia|date=2012-12|title=How to choose the double-lumen tube size and side: the eternal debate|url=https://pubmed.ncbi.nlm.nih.gov/23089502|journal=Anesthesiology Clinics|volume=30|issue=4|pages=671–681|doi=10.1016/j.anclin.2012.08.001|issn=1932-2275|pmid=23089502}}</ref> | |||
** Left tracheobronchial repair | ** Left tracheobronchial repair | ||
** Consider for left thoracoscopic lung procedures (can be accomplished with L-DLT as well) | ** Consider for left thoracoscopic lung procedures (can be accomplished with L-DLT as well) | ||
==== Tube Size Selection ==== | ==== Tube Size Selection ==== | ||
Several sources of literature help anesthesiologists choose the correct size DLT: | |||
# Pedoto (2012)<ref name=":1" /> | |||
# Brodsky et al. (1999)<ref>{{Cite journal|last=Brodsky|first=J. B.|last2=Fitzmaurice|first2=B. G.|last3=Macario|first3=A.|date=1999-02|title=Selecting double-lumen tubes for small patients|url=https://pubmed.ncbi.nlm.nih.gov/9972778|journal=Anesthesia and Analgesia|volume=88|issue=2|pages=466–467|doi=10.1097/00000539-199902000-00049|issn=0003-2999|pmid=9972778}}</ref> | |||
# Hao etl al. (2021)<ref name=":0" /> | |||
== Complications == | |||
* Laryngitis | |||
* Tracheal irritation | |||
* Vocal cord palsy | |||
* Airway rupture or perforation (<1% total incidence<ref>{{Cite journal|last=Fitzmaurice|first=B. G.|last2=Brodsky|first2=J. B.|date=1999-06|title=Airway rupture from double-lumen tubes|url=https://pubmed.ncbi.nlm.nih.gov/10392687|journal=Journal of Cardiothoracic and Vascular Anesthesia|volume=13|issue=3|pages=322–329|doi=10.1016/s1053-0770(99)90273-2|issn=1053-0770|pmid=10392687}}</ref>): trachea (52.4%) and left main bronchus (37.4%) are the most common sites<ref>{{Cite journal|last=Liu|first=Shiqing|last2=Mao|first2=Yuqiang|last3=Qiu|first3=Peng|last4=Faridovich|first4=Khasanov Anvar|last5=Dong|first5=Youjing|date=2020-11|title=Airway Rupture Caused by Double-Lumen Tubes: A Review of 187 Cases|url=https://pubmed.ncbi.nlm.nih.gov/33079871|journal=Anesthesia and Analgesia|volume=131|issue=5|pages=1485–1490|doi=10.1213/ANE.0000000000004669|issn=1526-7598|pmid=33079871}}</ref> | |||
== Technical Specifications == | == Technical Specifications == | ||
== References == | == References == | ||
[[Category:Surgical procedures]] | [[Category:Surgical procedures]] |
Revision as of 10:36, 16 October 2021
Double-lumen endotracheal tube
Anesthesia type |
Thoracic anesthesia |
---|---|
Airway | |
Lines and access | |
Monitors | |
Primary anesthetic considerations | |
Preoperative | |
Intraoperative |
Hypoxemia Misplacement Inadvertent airway suturing Airway perforation |
Postoperative |
Traumatic Laryngitis Vocal cord palsy Tracheal irritation |
Article quality | |
Editor rating | |
User likes | 0 |
Provide a brief summary of this surgical procedure and its indications here.
Indications[1]
- Hemorrhage an infected abscess into a single lung requiring isolation
- Controlled distributed ventilation for surgery
- Bronchopleural fistula, large lung bulla and or cysts
- Tracheobronchial disruption
- Single-lung lavage for pulmonary alveolar proteinosis
Contraindications
- Known difficult airway
- Tracheal stenosis
- Severe airway distortion
Setup
Operating room setup
- DLT with appropriately chosen size
- Laryngoscope (video or direct laryngoscope)
- Syringes 3mL (bronchial cuff) and 10mL (tracheal cuff)
- Fiberoptic bronchoscope for confirming post-placement position
- Consider tooth guard to prevent shearing tracheal balloon during placement
Tube Selection Selection
- Most single-lung ventilation procedures can be accomplished with a left-sided DLT
- Right DLT indications
- Left pneumonectomy
- Left lung transplant
- Trauma to the left mainstem bronchus[2]
- Left tracheobronchial repair
- Consider for left thoracoscopic lung procedures (can be accomplished with L-DLT as well)
Tube Size Selection
Several sources of literature help anesthesiologists choose the correct size DLT:
Complications
- Laryngitis
- Tracheal irritation
- Vocal cord palsy
- Airway rupture or perforation (<1% total incidence[4]): trachea (52.4%) and left main bronchus (37.4%) are the most common sites[5]
Technical Specifications
References
- ↑ 1.0 1.1 Hao, David; Saddawi-Konefka, Daniel; Low, Sarah; Alfille, Paul; Baker, Keith (2021-10-14). Ingelfinger, Julie R. (ed.). "Placement of a Double-Lumen Endotracheal Tube". New England Journal of Medicine. 385 (16): e52. doi:10.1056/NEJMvcm2026684. ISSN 0028-4793.
- ↑ 2.0 2.1 Pedoto, Alessia (2012-12). "How to choose the double-lumen tube size and side: the eternal debate". Anesthesiology Clinics. 30 (4): 671–681. doi:10.1016/j.anclin.2012.08.001. ISSN 1932-2275. PMID 23089502. Check date values in:
|date=
(help) - ↑ Brodsky, J. B.; Fitzmaurice, B. G.; Macario, A. (1999-02). "Selecting double-lumen tubes for small patients". Anesthesia and Analgesia. 88 (2): 466–467. doi:10.1097/00000539-199902000-00049. ISSN 0003-2999. PMID 9972778. Check date values in:
|date=
(help) - ↑ Fitzmaurice, B. G.; Brodsky, J. B. (1999-06). "Airway rupture from double-lumen tubes". Journal of Cardiothoracic and Vascular Anesthesia. 13 (3): 322–329. doi:10.1016/s1053-0770(99)90273-2. ISSN 1053-0770. PMID 10392687. Check date values in:
|date=
(help) - ↑ Liu, Shiqing; Mao, Yuqiang; Qiu, Peng; Faridovich, Khasanov Anvar; Dong, Youjing (2020-11). "Airway Rupture Caused by Double-Lumen Tubes: A Review of 187 Cases". Anesthesia and Analgesia. 131 (5): 1485–1490. doi:10.1213/ANE.0000000000004669. ISSN 1526-7598. PMID 33079871. Check date values in:
|date=
(help)
Top contributors: Nirav Kamdar, Chetra Yean and Gang Chen