Predicting the depth of insertion of left-sided double-lumen endobronchial tubes.
OBJECTIVE
To analyze the parameters that predict the depth of insertion of a left-sided double-lumen tube (DLT) and to assess the accuracy of the parameters after intubation.


METHODS
Prospective.


METHODS
Tertiary-care hospital.


METHODS
Patients undergoing 1-lung ventilation for thoracic surgery (n = 240).


METHODS
In the first 121 patients, the ideal depth of insertion was verified using fiberoptic bronchoscopy in the lateral position. Multiple regression analysis was used to find the correlation of this depth of insertion to the patients' height, weight, age, and the clavicular-to-carinal distance of the trachea measured from the chest radiograph. Another 119 patients were studied in whom the DLT was inserted blindly using the best regression line. The accuracy of the technique was assessed by fiberoptic bronchoscopy.


RESULTS
The depth of DLT insertion correlated significantly (p < 0.05) only with the height and clavicular-to-carinal distance of the trachea of the patients with the best regression line: Depth of insertion (cm) = 0.75 x clavicular-to-carinal distance of trachea (cm) + 0.112 x height (cm) + 6 with R(2) = 0.62 and p < 0.001. Using this best regression line, the DLT was placed in an acceptable position in 93 patients in the lateral position (positive predictive value of 78.2%) without further intraoperative adjustments.


CONCLUSIONS
The ideal depth of insertion of the left-sided DLT correlated significantly with patients' height and clavicular-to-carinal distance of the trachea. The best regression line enabled the left-sided DLT to be placed in an acceptable position without complications nearly 80% of the time.
Chow
Mark Yew-Hoong
MY
Department of Anaesthesia and Surgical Intensive Care Unit, Singapore General Hospital, Singapore. markchow@bigfoot.com
Goh
Meng-Huat
MH
Ti
Lian-Kah
LK
D000328:Adult; D000368:Aged; D001827:Body Height; D001980:Bronchi / Q000601:surgery*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013223:Statistics as Topic; D019616:Thoracic Surgical Procedures; D014057:Tomography, X-Ray Computed; D014132:Trachea / Q000601:surgery