Double-lumen endotracheal tube

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:

Pedoto (2012)^[2]
Brodsky et al. (1999)^[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

↑ ^1.0 ^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

[:0-1] 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.

[:1-2] 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)

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