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Misplacement of left-sided double-lumen tubes into the right mainstem bronchus: incidence, risk factors and blind repositioning techniques

Authors
 Jeong-Hwa Seo  ;  Jun-Yeol Bae  ;  Hyun Joo Kim  ;  Deok Man Hong  ;  Yunseok Jeon  ;  Jae-Hyon Bahk 
Citation
 BMC Anesthesiology, Vol.15 : 157-157, 2015 
Journal Title
 BMC Anesthesiology 
ISSN
 1471-2253 
Issue Date
2015
Abstract
BACKGROUND: Double-lumen endobronchial tubes (DLTs) are commonly advanced into the mainstem bronchus either blindly or by fiberoptic bronchoscopic guidance. However, blind advancement may result in misplacement of left-sided DLTs into the right bronchus. Therefore, incidence, risk factors, and blind repositioning techniques for right bronchial misplacement of left-sided DLTs were investigated. METHODS: This was an observational cohort study performed on the data depository consecutively collected from patients who underwent intubation of left-sided DLTs for 2 years. Patients' clinical and anatomical characteristics were analyzed to investigate risk factors for DLT misplacements with logistic regression analysis. Moreover, when DLTs were misplaced into the right bronchus, the bronchial tube was withdrawn into the trachea and blindly readvanced without rotation, or with 90° or 180° counterclockwise rotation while the patient's head was turned right. RESULTS: DLTs were inadvertently advanced into the right bronchus in 48 of 1135 (4.2 %) patients. DLT misplacements occurred more frequently in females, in patients of short stature or with narrow trachea and bronchi, and when small-sized DLTs were used. All of these factors were significantly inter-correlated each other (P < 0.001). In 40 of the 48 (83.3 %) patients, blind repositioning was successful. CONCLUSIONS: Smaller left-sided DLTs were more frequently misplaced into the right mainstem bronchus than larger DLTs. Moreover, we were usually able to reposition the misplaced DLTs into the left bronchus by using the blind techniques.
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/141778
DOI
10.1186/s12871-015-0138-1
Appears in Collections:
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실)
Yonsei Authors
김현주(Kim, Hyun Joo)
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