title: Positioning of double-lumen tubes based on the minimum peak inspiratory pressure difference between the right and left lungs in short patients: a prospective observational study.
abstract: BACKGROUND
  Peak inspiratory pressures (PIPs) during one-lung ventilation (OLV) have served as a clinical marker that could indirectly verify the proper positioning of double-lumen tubes (DLTs). Patients of short stature are highly susceptible to initial DLT malpositioning.
  
  
  OBJECTIVE
  We investigated the usefulness of positioning left-sided DLTs using minimum PIP differences between the right and left lungs by comparing with the previously used method of auscultation without fibreoptic bronchoscopy (FOB). We also evaluated the difference in PIPs between the two lungs during OLV after the DLT was ideally positioned with FOB examination.
  
  
  METHODS
  Prospective, observational study.
  
  
  METHODS
  A university hospital.
  
  
  METHODS
  One hundred and two female patients of short stature (≤160  cm).
  
  
  METHODS
  Verification of DLT position was conducted by three sequential steps: auscultation; minimising the difference in PIP during each OLV; and verifying the resulting position by FOB.
  
  
  METHODS
  Fibreoptic bronchoscopic view results of DLT position followed by the position adjustment using the minimum PIP difference method.
  
  
  RESULTS
  Repositioning the DLT using the minimum PIP difference led to clinically successful positioning of the DLT in 88% of patients and a more ideal placement of the tube than auscultation alone (69.6 vs. 11.8%, P <0.001). Additionally, the ideal position of DLTs verified by FOB showed that PIP differences were zero or ±1  mmHg in 93% of patients.
  
  
  CONCLUSIONS
  Positioning the DLT based on the minimum PIP difference between the right and left lungs as a supplementation to routine auscultation serves as an easy and reliable method for DLT positioning and may improve the accuracy of DLT positioning as an adjuvant to FOB in short patients.
  
  
  BACKGROUND
  Clinicaltrial.gov identifier: NCT01533012.
authors.affiliation: From the Department of Anaesthesiology and Pain Medicine, Anaesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Shin H
authors.initials: SH
authors.lastname: Kim
authors.forename: Yong S
authors.initials: YS
authors.lastname: Choi
authors.forename: Seokyung
authors.initials: S
authors.lastname: Shin
authors.forename: Jin S
authors.initials: JS
authors.lastname: Cho
authors.forename: Da J
authors.initials: DJ
authors.lastname: Nam
authors.forename: Young J
authors.initials: YJ
authors.lastname: Oh
mesh_terms: D000328:Adult; D000368:Aged; D001827:Body Height; D001999:Bronchoscopy / Q000295:instrumentation / Q000379:methods*; D004867:Equipment Design; D005260:Female; D005336:Fiber Optic Technology; D006785:Hospitals, University; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation / Q000379:methods*; D008168:Lung / Q000378:metabolism; D008875:Middle Aged; D061810:One-Lung Ventilation / Q000295:instrumentation / Q000379:methods*; D011446:Prospective Studies