Difference between revisions of "Double-lumen endotracheal tube"
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== 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 | * 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 | ||
| Line 28: | Line 28: | ||
* Known difficult airway | * Known difficult airway | ||
* Tracheal stenosis | * 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 == | == Setup == | ||
| Line 39: | Line 40: | ||
* 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 |
| Article quality | |
| Editor rating | |
| 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:
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)
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