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 surgery
| 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.
A double-lumen endotracheal tube (DLT) is an airway device that is commonly used to facilitate one-lung ventilation strategy in [[thoracic surgery]], lung transplantation, or infection and trauma management of a single lung.  


== 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 and infected abscess/spillage in a single lung requiring isolation
* Controlled distributed ventilation for surgery
* Controlled distributed ventilation for surgery
* Bronchopleural fistula, large lung bulla and or cysts
* Bronchopleural fistula, large lung bulla and or cysts
* Tracheobronchial disruption  
* Tracheobronchial disruption  
* Single-lung lavage for pulmonary alveolar proteinosis  
* Single-lung lavage for pulmonary alveolar proteinosis  
=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===


== Contraindications ==
== Contraindications ==
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* Known difficult airway
* Known difficult airway
* Tracheal stenosis
* Tracheal stenosis
* Severe airway distortion
* Airway distortion, lesions, masses that would preclude safe placement (e.g. tumors, airway strictures)
 
*Presence of right upper bronchus takeoff above the carina (colloquially known as "pig bronchus") is an absolute contraindication for use of right sided DLTs
=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> ===
 
=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===
 
=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===
 
=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===


== Setup ==
== Setup ==
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* Fiberoptic bronchoscope for confirming post-placement position
* Fiberoptic bronchoscope for confirming post-placement position
* Consider tooth guard to prevent shearing tracheal balloon during placement
* Consider tooth guard to prevent shearing tracheal balloon during placement
*Water based lubricant applied to outside of ETT to facilitate placement (optional)
=== 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<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
** 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:
# 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]]

Latest revision as of 07:23, 20 August 2023

Double-lumen endotracheal tube
Anesthesia type

Thoracic surgery

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
In development
User likes
0

A double-lumen endotracheal tube (DLT) is an airway device that is commonly used to facilitate one-lung ventilation strategy in thoracic surgery, lung transplantation, or infection and trauma management of a single lung.

Indications[1]

  • Hemorrhage and infected abscess/spillage in 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
  • Airway distortion, lesions, masses that would preclude safe placement (e.g. tumors, airway strictures)
  • Presence of right upper bronchus takeoff above the carina (colloquially known as "pig bronchus") is an absolute contraindication for use of right sided DLTs

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
  • Water based lubricant applied to outside of ETT to facilitate placement (optional)

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:

  1. Pedoto (2012)[2]
  2. Brodsky et al. (1999)[3]
  3. Hao etl al. (2021)[1]

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. ↑ 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. ↑ 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)
  3. ↑ 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)
  4. ↑ 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)
  5. ↑ 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

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