A NEW AND SIMPLE MANEUVER TO POSITION THE LEFT-SIDED DOUBLE-LUMEN TUBE WITHOUT THE AID OF FIBEROPTIC BRONCHOSCOPY

The double-lumen tube (DLT) is the mainstay of one-lung ventilation (O LV). We sought to determine whether this new intubation maneuver using an endobronchial cuff pressure could be substituted for verification by fiberoptic bronchoscope (FOB) in most conditions requiring left-sid ed DLT. Seventy-nine patients requiring video-assisted thoracoscopic s urgery for pneumothorax or mediastinal mass, or open thoracotomy for l ung or esophageal cancer were enrolled in this study. We used 35F (n = 23), 37F (n = 51), or 39F (n = 5) disposable polyvinyl chloride DLTs (Broncho-Cath(TM) Mallinckrodt Medical Ltd., Athlone, Ireland), depend ing on the height and gender of the patients. The DLTs were inserted d eeply until resistance was felt. At that time, the pilot of the endobr onchial cuff was connected to the Control-Inflator(R) (VBM Medizintech nik GmbH, Suit am Neckar, Germany) via a three-way stopcock. The bronc hial balloon was inflated with 1.0-2.0 mL of air through the stopcock until approximately 30 cm H2O of cuff pressure was obtained. The DLT w as slowly withdrawn until the pressure of the Control-Inflator(R) decr eased to approximately half the peak pressure during the initial phase of removal. At that time, the bronchial balloon was deflated, and the DLT was advanced approximately 1.0 cm (1.5 cm for the 39F DLT); using FOE, its position was checked by an independent observer not involved in positioning the DLTs. The ideal position was defined as that in wh ich the carina was located at the same level with the middle 5 mm betw een the proximal margin of the endobronchial balloon and the circumfer ential black mark. In 50 patients the position was ideal, and in 27 pa tients it was not ideal but was within the margin of the safety. There were only two failures. We conclude that if a FOE is unavailable or i napplicable, this simple and new maneuver may be used as a substitute during the positioning of DLTs. Implications: The correct position of the double-lumen tube is vital for one-lung ventilation, which has bee n confirmed with a fiberoptic bronchoscope. We devised a simple maneuv er to position the double-lumen tube correctly without a fiberoptic br onchoscope.