title: Fluoroscopic guidance for placing a double lumen endotracheal tube in adults.
abstract: OBJECTIVE
  The aim of this study was to assess the right placement of the double lumen endotracheal tube with fluoroscopic guidance, which is used in first intention prior to the fiberscope in our institution.
  
  
  METHODS
  This was a prospective observational study. The study was conducted in vascular and thoracic operating rooms. We enrolled 205 patients scheduled for thoracic surgery, with ASA physical statuses of I (n = 37), II (n = 84), III (n = 80), and IV (n = 4). Thoracic procedures were biopsy (n = 20), wedge (n = 34), culminectomy (n = 6), lobectomy (n = 82), pneumonectomy (n = 4), sympathectomy (n = 9), symphysis (n = 47), and thymectomy (n = 3). The intubation with a double lumen tube was performed with the help of a laryngoscope. Tracheal and bronchial balloons were inflated and auscultation was performed after right and left exclusions. One shot was performed to locate the position of the bronchial tube and the hook. Fluoroscopic guidance was used to relocate the tube in case of a wrong position. When the fluoroscopic guidance failed to position the tube, a fiberscope was used. Perioperative collapse of the lung was assessed by the surgeon during the surgery.
  
  
  RESULTS
  Correct fluoroscopic image was obtained after the first attempt in 58.5% of patients therefore a misplaced position was encountered in 41.5%. The fluoroscopic guidance allowed an exact repositioning in 99.5% of cases, and the mean duration of the procedure was 8 minutes. A fiberscope was required to move the hook for one patient. We did not notice a moving of the double lumen endotracheal tube during the surgery. The surgeon satisfaction was 100%.
  
  
  CONCLUSIONS
  The fluoroscopy evidenced the right position of the double lumen tube and allowed a right repositioning in 99.5% of patients with a very simple implementation.
authors.affiliation: Department of Anesthesia, Rouen University Hospital, Centre Hospitalier Universitaire de Rouen, Rouen, France. Electronic address: emile.calenda@chu-rouen.fr.
authors.forename: Emile
authors.initials: E
authors.lastname: Calenda
authors.affiliation: Department of Thoracic Surgery, Rouen University Hospital, Centre Hospitalier Universitaire de Rouen, Rouen, France.
authors.forename: Jean Marc
authors.initials: JM
authors.lastname: Baste
authors.affiliation: Department of Anesthesia, Rouen University Hospital, Centre Hospitalier Universitaire de Rouen, Rouen, France.
authors.forename: Ridha
authors.initials: R
authors.lastname: Hajjej
authors.affiliation: Department of Anesthesia, Rouen University Hospital, Centre Hospitalier Universitaire de Rouen, Rouen, France.
authors.forename: Najiba
authors.initials: N
authors.lastname: Rezig
authors.affiliation: Department of Anesthesia, Rouen University Hospital, Centre Hospitalier Universitaire de Rouen, Rouen, France.
authors.forename: Jerome
authors.initials: J
authors.lastname: Moriceau
authors.affiliation: Department of Anesthesia, Rouen University Hospital, Centre Hospitalier Universitaire de Rouen, Rouen, France.
authors.forename: Yaya
authors.initials: Y
authors.lastname: Diallo
authors.affiliation: Department of Anesthesia, Rouen University Hospital, Centre Hospitalier Universitaire de Rouen, Rouen, France.
authors.forename: Slim
authors.initials: S
authors.lastname: Sghaeir
authors.affiliation: Department of Anesthesia, Rouen University Hospital, Centre Hospitalier Universitaire de Rouen, Rouen, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Danielou
authors.affiliation: Department of Thoracic Surgery, Rouen University Hospital, Centre Hospitalier Universitaire de Rouen, Rouen, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Peillon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005471:Fluoroscopy; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies
keywords: Carlens tube; fluoroscopy; one-lung ventilation; thoracic surgery