Double-lumen endotracheal tube
Anesthesia type Thoracic surgery
Lines and access
Primary anesthetic considerations
Intraoperative Hypoxemia

Misplacement Inadvertent airway suturing

Airway perforation
Postoperative Traumatic Laryngitis

Vocal cord palsy

Tracheal irritation

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.


  • 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


  • Known difficult airway
  • Tracheal stenosis
  • Severe airway distortion


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[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]


  • 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


  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)