The incidence of right upper-lobe collapse when comparing a right-sided double-lumen tube versus a modified left double-lumen tube for left-sided thoracic surgery.

UNLABELLED: Lung deflation for left-sided thoracic surgery can be accomplished by using either a left- or right-sided double-lumen endotracheal tube (L-DLT or R-DLT). Anatomic variability of the right mainstem bronchus and the possibility of right upper-lobe obstruction have discouraged the routine use of R-DLT. There are, however, situations in which it is preferable to avoid manipulation/intubation of the left main bronchus, requiring placement of a R-DLT. We compared the modified L-DLT with the R-DLT to determine whether R-DLTs can be used during left-sided thoracic surgery without an increased risk of right upper-lobe collapse. Forty patients requiring left lung deflation were randomly assigned to one of two groups. Twenty patients received a modified L-DLT BronchoCath((R)) (Mallinckrodt Medical Inc., St. Louis, MO), and 20 received a R-DLT BronchoCath((R)). The following variables were studied: 1) time required to position each tube until satisfactory placement was achieved; 2) number of times fiberoptic bronchoscopy was required to readjust tube position; 3) number of malpositions after initial tube placement; 4) time required for left lung collapse; 5) incidence of right upper-lobe collapse from an intraoperative chest radiograph obtained in a lateral decubitus position; 6) overall surgical exposure; and 7) tube acquisition cost. Median time required for initial tube placement was greater in the R-DLT group (3.4 min) versus the L-DLT (2.1 min); P = 0.04. Overall tube cost was also larger for the R-DLT group (US $1819.40) versus the L-DLT group (US $1107.75). The incidence of malpositions, (five versus two), need for fiberoptic bronchoscopy, time for adequacy of left lung collapse, and incidence of intraoperative right upper-lobe collapse (0) did not significantly differ between R-DLT and L-DLT groups. We conclude that R-DLTs can be used for left-sided thoracic surgery without an increased risk of right upper-lobe collapse. Our data suggest that R-DLTs may be more prone to intraoperative dislodgment/malposition than L-DLTs; however, in all cases, correction of malposition was easily achieved. IMPLICATIONS: In this study, right-sided double-lumen tubes (R-DLTs) were compared with modified left-sided double-lumen tubes in patients requiring one-lung ventilation for left-sided thoracic surgery. The incidence of right upper-lobe collapse was assessed intraoperatively by a chest radiograph which showed no collapse of the right upper lobe in all patients who received R-DLTs or left-sided double-lumen tubes. Therefore, we conclude that R-DLTs present no increased risk of complications for left-sided thoracic surgery and should not be abandoned.

Is there a better right-sided tube for one-lung ventilation? A comparison of the right-sided double-lumen tube with the single-lumen tube with right-sided enclosed bronchial blocker.

UNLABELLED: Anatomic variation between tracheal carina and the take-off of the right upper bronchus often makes the use of a right-sided double-lumen tube (R-DLT) or a single-lumen tube with right-sided enclosed bronchial blocker tube (R-UBB) (Univent) undesirable. This study compared the R-DLT with the R-UBB to determine whether there was any advantage of one over the other during anesthesia with one-lung ventilation (OLV) for right-sided thoracic surgeries. Forty patients requiring right lung deflation were randomly assigned to one of two groups. Twenty patients received a right-sided BronchoCath double-lumen tube, and 20 received a Univent tube with a bronchial blocker placed in the right mainstem bronchus. The following were studied: 1) time required to position each tube until satisfactory placement was achieved; 2) number of times that fiberoptic bronchoscopy was required (including one with the patient supine and one in lateral decubitus position); 3) number of malpositions after initial confirmation of tube placement; 4) time required until lung collapse; 5) surgical exposure; and 6) cost of tubes per case. No differences were found with any of these variables except that the cost of acquisition overall was greater for the R-UBB than for the R-DLT. No right upper lobe collapse was observed in the postoperative period in the chest radiograph in any of the patients studied. We conclude that either tube can be used safely and effectively for right-sided thoracic surgeries that require anesthesia for OLV. IMPLICATIONS: In this study, right-sided double-lumen tubes were compared with the Univent with right-sided bronchial blockers. The results indicate that either tube can be used for right-sided thoracic surgery.