Comparison between computerized tomography-guided bronchial width measurement versus conventional method for selection of adequate double lumen tube size
| Autor: | Harkant Singh, Praneeth Suvvari, Manphool Singhal, Bhupesh Kumar |
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| Rok vydání: | 2019 |
| Předmět: |
Male
lcsh:Diseases of the circulatory (Cardiovascular) system medicine.medical_treatment Safety margin 030204 cardiovascular system & hematology Radiography Interventional Cohort Studies 0302 clinical medicine 030202 anesthesiology safety margin Fiber Optic Technology Thoracotomy Prospective Studies Lung double lumen tube size selection education.field_of_study Singapore Age Factors General Medicine Middle Aged One-Lung Ventilation Europe Bronchoscopes Fiberoptic bronchoscope Female Original Article Tomography Cardiology and Cardiovascular Medicine Right upper lobe bronchus Adult Population Bronchi lcsh:RD78.3-87.3 bronchial diameter 03 medical and health sciences Bronchoscopy medicine Intubation Intratracheal Humans education Selection (genetic algorithm) Double lumen tube Adequacy of lung isolation business.industry Anesthesiology and Pain Medicine lcsh:Anesthesiology lcsh:RC666-701 Nuclear medicine business Tomography X-Ray Computed |
| Zdroj: | Annals of Cardiac Anaesthesia Annals of Cardiac Anaesthesia, Vol 22, Iss 4, Pp 358-364 (2019) |
| ISSN: | 0974-5181 |
| Popis: | Background: Selection of adequate size double lumen tube (DLT) is complicated by marked inter-individual variability in morphology and dimensions of tracheobronchial tree. Computerized tomography (CT)-guided left bronchus width measurement has been used to predict adequate size DLT in European and Singapore population; however, no such data exist for Indian population who are racially different. We compared the effect of DLT size selection based on CT-guided bronchial width measurement to the conventional method of DLT selection on the adequacy of both lungs isolation and on the safety margin of right-sided DLT. Methods: Fifty-five adults scheduled to undergo thoracotomy were enrolled in this prospective observational study. An appropriate size left- or right-sided DLT with outer diameter 0.5–1 mm smaller than the CT-measured bronchial width was selected for the isolation of lungs. Adequacy of separation was checked using fiberoptic bronchoscope. The safety margin of selected right-sided DLT size was calculated from CT-measured right upper lobe bronchus width and diameter of right upper lobe ventilation slot of the DLT. Results: Adequate separation of lungs was achieved in 92.7% of studied population, 90.9% in males, and 95.4% in females. Among these, 54.9% patients required different sized DLT as compared to conventional method. Overall safety of margin of right-sided DLTs was comparable between two methods of DLT selection (median [IQR] 4.8 (3.5–6.8) vs. 6.59 (3.5–7.8), P = 0.317). DLT size with adequate isolation of lung correlated with height, tracheal width (TW) on chest X-ray, and age of the patients. A formula to calculate DLT size based on these variable was derived. Conclusion: CT-measured bronchial width predicts the appropriate DLT size better than conventional method. In the absence of CT scan facility, patient height, age, and chest X-ray TW may be used to predict DLT size with reasonable accuracy. |
| Databáze: | OpenAIRE |
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