EVALUATION OF AN APPROACH TO CHOOSING A LEFT DOUBLE-LUMEN TUBE SIZE BASED ON CHEST COMPUTED TOMOGRAPHIC SCAN MEASUREMENT OF LEFT MAINSTEM BRONCHIAL DIAMETER

Objective: Evaluation of an approach to choosing left double-lumen tub e size based on chest computed tomographic (CT) scan measurement of le ft bronchial diameter. Design: Prospective. Setting: The operating roo ms of a university hospital. Participants: Patients scheduled for elec tive thoracic surgery. Interventions: Patients had their left bronchia l diameter measured on the preoperative chest CT scan. Left double-lum en tube size for the individual patient was chosen from a protocol bas ed on left bronchial diameter. Measurements and Main Results: The doub le-lumen tube size was considered appropriate for the patient if some air leak was detected when the bronchial cuff was deflated and if airt ight seal of the left bronchus was obtained with a bronchial cuff volu me of 2 mL or less. In 17 of 20 patients, the double-lumen tube size f ulfilled both criteria. In 3 women with left bronchi measuring 10 mm o r less, the bronchus was sealed without any air in the bronchial cuff of size 35 Pr left double-lumen tubes, In 1 patient, who was excluded from the study, the double-lumen-tube size was chosen based on measure ment of the left bronchial diameter on chest radiograph because of mot ion artifact on the chest CT scan. Conclusions: Chest CT scan measurem ent of left bronchial diameter can successfully guide the choice of le ft double-lumen tube size for an individual patient. In individuals wi th a small left bronchus measuring less than 10.0 mm in diameter, curr ently available adult double-lumen tube sizes will tightly wedge in th eir bronchus. Copyright (C) 1997 by W.B. Saunders Company.