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A modified technique to improve the outcome of intubation with a left-sided double-lumen endobronchial tube

BACKGROUND: The use of a video-assisted laryngoscope (VL) has been shown to reduce the time to achieve intubation with a double-lumen endobronchial tube (DLT). As the blade of the VL is curved differently to a standard laryngoscope, the DLT must be angled into a hockey stick shape to fit properly. W...

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Autores principales: Hsu, Hung-Te, Chou, Shah-Hwa, Chou, Chun-Yen, Tseng, Kuang-Yi, Kuo, Yi-Wei, Chen, Mei-Chun, Cheng, Kuang-I
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4158352/
https://www.ncbi.nlm.nih.gov/pubmed/25206313
http://dx.doi.org/10.1186/1471-2253-14-72
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author Hsu, Hung-Te
Chou, Shah-Hwa
Chou, Chun-Yen
Tseng, Kuang-Yi
Kuo, Yi-Wei
Chen, Mei-Chun
Cheng, Kuang-I
author_facet Hsu, Hung-Te
Chou, Shah-Hwa
Chou, Chun-Yen
Tseng, Kuang-Yi
Kuo, Yi-Wei
Chen, Mei-Chun
Cheng, Kuang-I
author_sort Hsu, Hung-Te
collection PubMed
description BACKGROUND: The use of a video-assisted laryngoscope (VL) has been shown to reduce the time to achieve intubation with a double-lumen endobronchial tube (DLT). As the blade of the VL is curved differently to a standard laryngoscope, the DLT must be angled into a hockey stick shape to fit properly. We conducted a study to establish which direction of angulation was best to facilitate correct positioning of the DLT when using a VL. METHODS: We enrolled patients scheduled for thoracic surgery who required intubation with a DLT. They were prospectively randomized into one of two groups: those intubated with a DLT angled to conceal the tracheal orifice (the tracheal orifice-covered, TOC) group or the tracheal orifice-exposed (TOE) group. The composite primary outcome measures were time taken to intubate and the frequency of first-time success. The time taken to intubate was divided into: T1, the time from mouth opening to visualization of the vocal cords with the VL; and T2, the time taken to advance the DLT through the cords until its tip lay within the trachea and three carbon dioxide waveforms had been detected by capnography. The hemodynamic responses to intubation and intubation-related adverse events were also recorded. RESULTS: Sixty-six patients completed the study, with 33 in each group. Total intubation time was significantly shorter in the TOC group (mean 30.6 ± standard deviation 2.7 seconds versus 38.7 ± 3.3 seconds, p <0.0001). T2 was also significantly shorter in the TOC group than the TOE group (27.2 ± 2.5 seconds versus 34.9 ± 3.0 seconds, p <0.0001). The severity of hoarseness on the first postoperative day and sore throat on the fourth postoperative day were significantly lower in the TOC group than the TOE group (p = 0.02 and <0.0001, respectively). The hemodynamic responses to intubation were broadly similar between the groups. CONCLUSION: When placing a left-sided DLT using a VL, angling the bronchial lumen to a hockey stick shape that conceals the tracheal lumen saves time and ameliorates the severity of post-intubation complications. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01605591.
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spelling pubmed-41583522014-09-10 A modified technique to improve the outcome of intubation with a left-sided double-lumen endobronchial tube Hsu, Hung-Te Chou, Shah-Hwa Chou, Chun-Yen Tseng, Kuang-Yi Kuo, Yi-Wei Chen, Mei-Chun Cheng, Kuang-I BMC Anesthesiol Research Article BACKGROUND: The use of a video-assisted laryngoscope (VL) has been shown to reduce the time to achieve intubation with a double-lumen endobronchial tube (DLT). As the blade of the VL is curved differently to a standard laryngoscope, the DLT must be angled into a hockey stick shape to fit properly. We conducted a study to establish which direction of angulation was best to facilitate correct positioning of the DLT when using a VL. METHODS: We enrolled patients scheduled for thoracic surgery who required intubation with a DLT. They were prospectively randomized into one of two groups: those intubated with a DLT angled to conceal the tracheal orifice (the tracheal orifice-covered, TOC) group or the tracheal orifice-exposed (TOE) group. The composite primary outcome measures were time taken to intubate and the frequency of first-time success. The time taken to intubate was divided into: T1, the time from mouth opening to visualization of the vocal cords with the VL; and T2, the time taken to advance the DLT through the cords until its tip lay within the trachea and three carbon dioxide waveforms had been detected by capnography. The hemodynamic responses to intubation and intubation-related adverse events were also recorded. RESULTS: Sixty-six patients completed the study, with 33 in each group. Total intubation time was significantly shorter in the TOC group (mean 30.6 ± standard deviation 2.7 seconds versus 38.7 ± 3.3 seconds, p <0.0001). T2 was also significantly shorter in the TOC group than the TOE group (27.2 ± 2.5 seconds versus 34.9 ± 3.0 seconds, p <0.0001). The severity of hoarseness on the first postoperative day and sore throat on the fourth postoperative day were significantly lower in the TOC group than the TOE group (p = 0.02 and <0.0001, respectively). The hemodynamic responses to intubation were broadly similar between the groups. CONCLUSION: When placing a left-sided DLT using a VL, angling the bronchial lumen to a hockey stick shape that conceals the tracheal lumen saves time and ameliorates the severity of post-intubation complications. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01605591. BioMed Central 2014-08-18 /pmc/articles/PMC4158352/ /pubmed/25206313 http://dx.doi.org/10.1186/1471-2253-14-72 Text en Copyright © 2014 Hsu et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Hsu, Hung-Te
Chou, Shah-Hwa
Chou, Chun-Yen
Tseng, Kuang-Yi
Kuo, Yi-Wei
Chen, Mei-Chun
Cheng, Kuang-I
A modified technique to improve the outcome of intubation with a left-sided double-lumen endobronchial tube
title A modified technique to improve the outcome of intubation with a left-sided double-lumen endobronchial tube
title_full A modified technique to improve the outcome of intubation with a left-sided double-lumen endobronchial tube
title_fullStr A modified technique to improve the outcome of intubation with a left-sided double-lumen endobronchial tube
title_full_unstemmed A modified technique to improve the outcome of intubation with a left-sided double-lumen endobronchial tube
title_short A modified technique to improve the outcome of intubation with a left-sided double-lumen endobronchial tube
title_sort modified technique to improve the outcome of intubation with a left-sided double-lumen endobronchial tube
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4158352/
https://www.ncbi.nlm.nih.gov/pubmed/25206313
http://dx.doi.org/10.1186/1471-2253-14-72
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