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
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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

• 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
  • 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. Brodsky et al. (1999)
3. Hao etl al. (2021)

Complications

• Laryngitis
• Tracheal irritation
• Vocal cord palsy
• Airway rupture or perforation (<1% total incidence): trachea (52.4%) and left main bronchus (37.4%) are the most common sites