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How to choose the double-lumen tube size and side: the eternal debate. Pedoto Alessia Anesthesiology clinics Although disposable double-lumen tubes have been used for many years, there is still controversy regarding what size and which side to use for thoracic procedures requiring lung isolation. Thoracic and nonthoracic anesthesiologists often debate performance, efficiency, and outcome of small and large double-lumen tubes, and left- and right-sided tubes. This article focuses on current data in the literature and expert opinion on the topic. 10.1016/j.anclin.2012.08.001
Placement of the Double-Lumen Endotracheal Tube: One Size Doesn't Fit All. Joshi Brijen L,Lester Laeben C,Grant Michael C Journal of cardiothoracic and vascular anesthesia 10.1053/j.jvca.2017.09.029
Changing double-lumen tracheal tube curvature. Maheshwari P Anaesthesia 10.1111/anae.13201
180° rotation of double-lumen endobronchial tube during intubation. Bahk J-H,Seo J-H British journal of anaesthesia 10.1093/bja/aeu114
Placement of a Double-Lumen Endotracheal Tube. Reply. Hao David,Saddawi-Konefka Daniel,Baker Keith The New England journal of medicine 10.1056/NEJMc2117870
Two-handed jaw thrust in patients undergoing intubation with a double-lumen endobronchial tube. Hu Bailong,Zhou Haiyan,Zou Xiaohua European journal of anaesthesiology 10.1097/EJA.0000000000001283
Placement of a Double-Lumen Endotracheal Tube. Hu Bailong,Zhou Haiyan,Zou Xiaohua The New England journal of medicine 10.1056/NEJMc2117870
Double lumen endobronchial tube intubation: lessons learned from anatomy. BMC anesthesiology 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. 10.1186/s12871-024-02517-6