Journal Article

A method for addressing right upper lobe obstruction with right-sided double-lumen endobronchial tubes during surgery: a randomized controlled trial

Qi, Sihua, Ma, Xuesong, Wang, Zijian, Yu, Wei, Zhang, Wei, Gao, Dapeng, Jin, Wen

2018

Overview

Background A right-sided double-lumen tube (R-DLT) tends to obstruct the right upper lobe intraoperatively due to anatomical distortion during surgery. If the R-DLT is poorly matched with the patient’s airway anatomy, it will not be possible to correctly replace the tube with a fiberoptic bronchoscope (FOB). In our study, we aimed to explore an efficient method for difficult repositioning caused by right upper lobe occlusion during surgery: repositioning the R-DLT from the right main bronchus into the left main bronchus. The current study was designed to assess the efficacy and safety of this method. Methods Sixty adult patients scheduled to undergo left-sided thoracic surgery were randomly assigned to two groups. With the patient in the right lateral position during surgery, the R-DLT was pulled back to the trachea while being rotated 90° clockwise; it was then either rotated 90° clockwise for placement into the left main bronchus (Group L) or rotated 90° anticlockwise and returned to the right main bronchus (Group R) using FOB guidance. The primary outcomes included clinical performance, which was measured by intubation time, and the quality of lung collapse. A secondary outcome was safety, which was determined according to bronchial injury and vocal cord injury. Results The median intubation time (IQR [range]) required for placement of a R-DLT into the left main bronchus was shorter than the time required for placement into the right main bronchus (15.0 s [IQR, 12.0 to 20.0 s]) vs 23.5 s [IQR, 14.5 to 65.8 s], P = 0.005). The groups showed comparable overall results for the quality of lung collapse during the total period of one-lung ventilation (P = 1.000). The numbers of patients with bronchial injuries or vocal cord injuries were also comparable between groups (Group R, 11/30 vs. Group L 8/30, P = 0.580 for bronchus injuries; Group R, 15/30 vs. Group L 13/30, P = 0.796 for vocal cord injuries). Conclusions Repositioning a R-DLT from the right main bronchus into the left main bronchus had good clinical performance without causing additional injury. This may be an efficient method for the difficult repositioning of a R-DLT due to right upper lobe occlusion during surgery. Trial registration Chinese Clinical Trial Registry, ChiCTR-IPR-15006933 , registered on 15 August 2015.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Aged / Airway and respiratory management / airway management methods, one-lung ventilation, adverse effects, intubation / Airway Obstruction - etiology / Airway Obstruction - prevention & control / Analysis / Anesthesia / Anesthesiology / Bronchoscopes - adverse effects / Bronchoscopes - trends / Bronchoscopy - adverse effects / Bronchoscopy - instrumentation / Bronchoscopy - trends / Bronchus / Care and treatment / Clinical trials / Critical Care Medicine / Emergency Medicine / Female / Hoarseness - etiology / Hoarseness - prevention & control / Humans / Injuries / Intensive / Internal Medicine / Intraoperative Care - methods / Intubation / Intubation, Intratracheal - adverse effects / Intubation, Intratracheal - instrumentation / Intubation, Intratracheal - trends / Lung diseases / Lungs / Male / Medical personnel / Medicine / Medicine & Public Health / Methods / Middle Aged / Occlusion / Ostomy / Patients / Peer review / Pharyngitis - etiology / Pharyngitis - prevention & control / Postoperative Complications - etiology / Postoperative Complications - prevention & control / Research Article / Respiratory tract / Single-Blind Method / Surgery / Thoracic surgery / Thorax / Trachea