title: Practice patterns in choice of left double-lumen tube size for thoracic surgery.
abstract: BACKGROUND
  Some anesthesiologists choose smaller than body size-appropriate left sided double-lumen tubes (DLTs) ("down-size") for lung isolation in an attempt to limit the risk of airway trauma. There are few data on the effects of DLT size on intraoperative outcome measures.
  
  
  METHODS
  In 300 adults undergoing thoracic surgery requiring lung isolation, we conducted a prospective pilot study to evaluate whether the use of 35 FR DLT, regardless of gender and/or height (care standard of two investigators), was associated with a similar incidence of intraoperative hypoxemia, lung isolation failure, or need for DLT repositioning during surgery (noninferiority) than with the conventional goal of inserting the largest possible DLT (care standard of two other investigators). DLT insertion position was immediately confirmed with fiberoptic bronchoscopy after direct laryngoscopic placement and after lateral positioning.
  
  
  RESULTS
  The combined incidence of transient hypoxemia, inadequate lung isolation, or need for DLT repositioning during surgery did not differ among patients receiving 35, 37, or 39 FR DLT, regardless of gender or height. Despite the high frequency of 35 FR DLT use, 2% of patients required further down-sizing due to the inability to introduce the DLT into the left mainstem bronchus or when no inflation of the bronchial cuff was needed for lung isolation.
  
  
  CONCLUSIONS
  Under the conditions of this pilot study, the use of smaller than conventionally sized DLT was not associated with any differences in clinical intraoperative outcomes.
authors.affiliation: Department of Anesthesiology, Memorial Sloan-Kettering Cancer Center and Weill Medical College of Cornell University, New York City, New York 10021, USA. amard@mskcc.org
authors.forename: David
authors.initials: D
authors.lastname: Amar
authors.forename: Dawn P
authors.initials: DP
authors.lastname: Desiderio
authors.forename: Paul M
authors.initials: PM
authors.lastname: Heerdt
authors.forename: Anne C
authors.initials: AC
authors.lastname: Kolker
authors.forename: Hao
authors.initials: H
authors.lastname: Zhang
authors.forename: Howard T
authors.initials: HT
authors.lastname: Thaler
mesh_terms: D000368:Aged; D002755:Choice Behavior; D004867:Equipment Design / Q000009:adverse effects; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011364:Professional Practice; D011446:Prospective Studies; D019616:Thoracic Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation*