title: Double-lumen tube placement with the patient in the supine position without a headrest minimizes displacement during lateral positioning.
abstract: OBJECTIVE
  The correct position of double-lumen tubes (DLTs) is customarily confirmed after tracheal intubation by bronchoscopy with the patient supine on a headrest. However, displacement of DLTs usually occurs during lateral positioning because of neck extension. This study was undertaken to determine whether displacement of DLTs could be minimized during lateral positioning if DLTs were positioned without a headrest.
  
  
  METHODS
  One hundred patients scheduled for thoracic surgery were randomized into two groups (n = 50 each). After tracheal intubation using a headrest, adjustment of DLT position was performed according to group assignment, i.e., either with the headrest in place or without the headrest. Using a bronchoscope, distances from the tracheal opening to the main carina and from the bronchial opening to the left bronchial carina were measured in both the supine and lateral positions.
  
  
  RESULTS
  Displacement of DLTs [mean (standard deviation)] during lateral positioning was greater in the headrest group than in the no-headrest group [12.3 (6.5) mm vs 6.8 (5.5) mm, respectively, in the trachea; 11.6 (6.7) mm vs 6.0 (4.6) mm, respectively, in the bronchus; P < 0.001]. The incidence of significant displacement, defined as > 10 mm from initial correct position, was greater in the headrest group than in the no-headrest group (64% vs 28%, respectively, in the trachea; 58% vs 20%, respectively, in the bronchus; P < 0.001).
  
  
  CONCLUSIONS
  Displacement of DLTs during lateral positioning appears to be caused primarily by extension of the neck. Correct adjustment of DLT position without a headrest in the supine position is an easy and effective method to minimize DLT displacement during lateral positioning.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, Korea.
authors.forename: Jeong-Hwa
authors.initials: JH
authors.lastname: Seo
authors.forename: Deok Man
authors.initials: DM
authors.lastname: Hong
authors.forename: Jung-Man
authors.initials: JM
authors.lastname: Lee
authors.forename: Eun-Jin
authors.initials: EJ
authors.lastname: Chung
authors.forename: Jae-Hyon
authors.initials: JH
authors.lastname: Bahk
mesh_terms: D000328:Adult; D000368:Aged; D001980:Bronchi; D001999:Bronchoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011187:Posture; D011446:Prospective Studies; D016683:Supine Position; D019616:Thoracic Surgical Procedures / Q000379:methods*; D014132:Trachea; D055815:Young Adult