New landmarks improve the positioning of the left Broncho-Cath (TM) double-lumen tube-comparison with the classic technique

Purpose: To compare a new technique (NT) for positioning the left modified Broncho-Cath((TM)) double-lumen tube (LM-DLT) by fibreoptic bronchoscopy (F OB) to the classic technique (CT). Methods: Sixty-one adult patients undergoing elective thoracic surgery with LM-DLT were randomly assigned to the NT or to the CT group. For the NT, th e endoscopist confirms the left mainstem endobronchial intubation. The prox imal edge of the blue bronchial cuff should not be visualized at the carina . Then, through the left bronchial lumen, by transparency across the wall o f the tube, the position of the tube is adjusted so that the carina lies mi dway between the black radiopaque line and the top of the bronchial cuff. A fter this, the orifice of the left upper lobe (LUL) bronchus should be clea rly seen. For the CT the endoscopist uses the technique described by Benumo f and Slinger. After lateral positioning of the patient, the LM-DLT was rep ositioned if the top of the endobronchial cuff was above the carina or when the LUL bronchus was obstructed. Results: The incidence of proximal repositioning was significantly less in the NT compared to the CT (16% vs 43%, P=0.007). Conclusion: Using this new technique, the LM-DLT is inserted deeper in the left mainstem bronchus. This new landmark augments the range of movement th at can be tolerated without requiring repositioning of the LM-DLT. This NT to position and to assess LM-DLT, by transparency across the wall of the tu be with FOB, is better adapted to the LM-DLT and its recent modifications.