Double lumen endobronchial tube intubation: lessons learned from anatomy.

Autor: Cameron RB; Division of Thoracic Surgery, Department of Surgery, David Geffen School of Medicine at UCLA and the Division of Thoracic Surgery, Department of Surgery and Perioperative Care, West Los Angeles VA Medical Center, Los Angeles, CA, USA., Peacock WJ; Department of Surgery, David Geffen School of Medicine at UCLA and the Division of Thoracic Surgery, Los Angeles, USA., Chang XG; Department of Surgery, David Geffen School of Medicine at UCLA and the Division of Thoracic Surgery, Los Angeles, USA., Shin JS; Department of Anesthesiology, David Geffen School of Medicine at UCLA and the Department of Anesthesiology, West Los Angeles VA Medical Center, Los Angeles, CA, USA. jshin@mednet.ucla.edu.; Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California, 757 Westwood Plaza, Suite 3325, Los Angeles, CA, 90095, USA. jshin@mednet.ucla.edu., Hoftman N; Department of Anesthesiology, David Geffen School of Medicine at UCLA and the Department of Anesthesiology, West Los Angeles VA Medical Center, Los Angeles, CA, USA.
Jazyk: angličtina
Zdroj: BMC anesthesiology [BMC Anesthesiol] 2024 Apr 19; Vol. 24 (1), pp. 150. Date of Electronic Publication: 2024 Apr 19.
DOI: 10.1186/s12871-024-02517-6
Abstrakt: Background: Double lumen endobronchial tubes (DLTs) are frequently used to employ single lung ventilation strategies during thoracic surgical procedures. Placement of these tubes can be challenging even for experienced clinicians. We hypothesized that airway anatomy, particularly of the glottis and proximal trachea, significantly impacts the ease or difficulty in placement of these tubes.
Methods: Images from 24 randomly selected Positron Emission Tomography - Computed Tomography (PET-CT) scans were evaluated for several anatomic aspects of the upper airway, including size and angulation of the glottis and proximal tracheal using calibrated CT measurements and an online digital protractor. The anatomic issues identified were confirmed in cadaveric anatomic models.
Results: Proximal tracheal diameter measurements in PET-CT scans demonstrated a mean ± standard deviation of 20.4 ± 2.5 mm in 12 males and 15.5 ± 0.98 mm in 12 females (p < 0.001), and both were large enough to accommodate 39 French and 37 French DLTs in males and females, respectively. Subsequent measurements of the posterior angulation of the proximal trachea revealed a mean angle of 40.8 ± 5.7 degrees with no sex differences. By combining the 24 individual posterior tracheal angles with the 16 angled distal tip measurements DLTs (mean angle 24.9 ± 2.1 degrees), we created a series of 384 patient intubation angle scenarios. This data clearly showed that DLT rotation to a full 180 degrees decreased the mean intubation angle between the DLT and the proximal trachea from a mean of 66.6 ± 5.9 to only 15.8 ± 5.9 degrees.
Conclusions: Rotation of DLTs a full 180 instead of the recommended 90 degrees facilitates DLT intubations.
(© 2024. The Author(s).)
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje