title: Use of a neck brace minimizes double-lumen tube displacement during patient positioning.
abstract: OBJECTIVE
  When patients are moved from the supine to the lateral decubitus position, the double-lumen endobronchial tube (DLT) is often displaced. The aim of this study was to determine whether a DLT is displaced when there are no movements of the head and neck.
  
  
  METHODS
  One hundred patients scheduled for elective thoracic surgery were randomly divided into control and brace groups. Only a left-sided DLT was used during the study. All patients in the brace group wore a neck collar before the positional change. Using a fibreoptic bronchoscope, the distance from the tracheal opening to the main carina and from the bronchial opening to the bronchial carina was measured in the supine and lateral decubitus positions.
  
  
  RESULTS
  Displacement of the DLT (mean +/- SD) during a change from the supine to the lateral decubitus position was greater in the control group (6.3 +/- 5.5 mm in the trachea; 2.4 +/- 3.6 mm in the bronchus) than in the brace group (2.2 +/- 3.9 mm in the trachea; 0.6 +/- 3.1 mm in the bronchus); (P < 0.001). The incidence of clinically significant displacement, greater than 5 mm from the initial correct position, was higher in the control group than in the brace group (48% vs 12%, P < 0.001).
  
  
  CONCLUSIONS
  By restricting head and neck movements with a neck brace, the DLT displacement could be minimized while positioning patients for thoracotomy. The main cause of the DLT displacement during lateral positioning appears to be related to movement of the head and neck.
authors.affiliation: Department of Anesthesiology, Seoul National University Hospital, Seoul National University College of Medicine, 28 Yongon-Dong, Chongno-Gu, Seoul, Korea.
authors.forename: Tae-Gyoon
authors.initials: TG
authors.lastname: Yoon
authors.forename: Hye-Won
authors.initials: HW
authors.lastname: Chang
authors.forename: Ho-Geol
authors.initials: HG
authors.lastname: Ryu
authors.forename: Tae-Dong
authors.initials: TD
authors.lastname: Kwon
authors.forename: Jae-Hyon
authors.initials: JH
authors.lastname: Bahk
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D009068:Movement; D009333:Neck; D011187:Posture; D013908:Thoracotomy