Difference between revisions of "Double-lumen endotracheal tube"

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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<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> ==
== 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
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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


== 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 ===
=== Tube Selection Selection ===

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

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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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