A comparison of the endobronchial segment of modern left-sided double-lumen tubes in anesthesia for bilateral sequential lung transplantation.
OBJECTIVE
To compare a range of currently available left-sided double-lumen endotracheal tubes (DLTs) in order to demonstrate differences among them with respect to the length of the endobronchial segment. It is proposed that a tube with a short endobronchial segment is better suited to anesthesia under the conditions imposed by double sequential lung transplantation.


METHODS
A university hospital with a large heart and lung transplant unit.


METHODS
The DLTs included in the study were Sher-I-Bronch (Sheridan of Kendall Australia, North Ryde, Sydney, Australia); BronchoCath and BronchoCath II (Mallinckrodt Medical, St Louis, MO); Rüsch single use (Rüsch, Wailbilngen, Germany); Portex single use (Portex, Keen, NH); and Phoenix single-use Robertshaw (Promedica, Preston, Lancashire, UK).


RESULTS
The endobronchial segment was measured as the distance from the point of inflation of the bronchial cuff to the tip of the tube. This distance was measured for each manufactured brand in a range of tubes and the mean obtained. The DLTs were compared to assess variability within the brand, and the influence of size on the endobronchial segment. All brands were then compared. Variability within brands is consistent with manufacturer's specified range of +/- 1 to 3 mm. The endobronchial segment increases with size for Rusch and Phoenix DLTs as a design feature. The average lengths of the endobronchial segments are Rusch 23 +/- 2 mm (sizes 35/37) and 25 +/- 2 mm (sizes 39/41); Mallinckrodt 30 +/- 3 mm (BronchoCath) and 31 +/- 3 mm (BronchoCath II); Portex 35 +/- 2 mm; Sheridan 35 +/- 2 mm; Phoenix 47 mm (small), 52 mm (medium), and 56 mm (large).


CONCLUSIONS
There exists marked variability in the length of the endobronchial segment of left-sided double-lumen tubes currently available. These differences may be significant in anesthesia for bilateral sequential lung transplantation.
Watterson
L M
LM
St. Vincent's Hospital, Darlinghurst, Sydney, Australia.
Harrison
G A
GA
D000758:Anesthesia; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D016040:Lung Transplantation