Computed tomography-based tracheobronchial image reconstruction allows selection of the individually appropriate double-lumen tube size

Objectives: To determine whether individualized selection of double-lumen t ubes or alternatives based on three-dimensional reconstruction of the trach eobronchial image from routine preoperative computed tomography (CT) scans leads to clinically appropriate choices. Design: Prospective observational study; comparison to historic controls. Setting: Anesthesia and radiology facilities of a university medical center . Participants: Forty-nine patients undergoing thoracic surgery requiring one -lung ventilation. Interventions: Three-dimensional image reconstruction of individual tracheo bronchial anatomy was performed from routine preoperative spiral CT scans a s well as from scans of five left-sided and four right-sided double-lumen t ubes. Results of image-based tube size selection were compared with literat ure recommendations. Prospectively, individualized tube selection was perfo rmed by superimposition of printed transparencies of tubes over the tracheo bronchial system and was validated using bronchoscopic and clinical criteri a (n = 24). Measurements and Main Results: Three-dimensional reconstruction visualized individual anatomy with good accuracy and resolution. Correlations between patient morphology and tracheobronchial dimensions were weak (height versus mainstem bronchial diameters: r < 0.50). In 11 of 48 patients (23%). CT-fi tted double-lumen tube sizes would have differed from a conventional height -based and gender-based selection. Individual, prospective, CT-based double -lumen tube selection was associated with (1) good fit and positioning conf irmed by fiberoptic bronchoscopy, (2) adequate bronchial cuff seal volumes, (3) complete lung separation, and (4) oxygenation and ventilation paramete rs during one-lung ventilation similar to those with conventional size sele ction. In one patient, three-dimensional CT study allowed noninvasive evalu ation of a tracheal stenosis precluding double-lumen tube placement. Conclusion: Individualized selection of double-lumen tube size using CT-bas ed reconstructions of tracheobronchial anatomy leads to clinically appropri ate choices, Risks resulting from variations in tracheobronchial morphology are recognized in advance. Copyright (C) 1999 by W.B. Saunders Company.