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Impact of obesity on double-lumen endobronchial tube displacement after lateral decubitus positioning

Authors
 Kyuho Lee  ;  Jin Soo Park  ;  Min-Soo Kim  ;  Nayoung Tae  ;  Dongwoo Lee  ;  Young Jun Oh 
Citation
 KOREAN JOURNAL OF ANESTHESIOLOGY, Vol.76(3) : 227-234, 2023-07 
Journal Title
KOREAN JOURNAL OF ANESTHESIOLOGY
ISSN
 2005-6419 
Issue Date
2023-07
MeSH
Bronchi ; Humans ; Intubation, Intratracheal* / adverse effects ; Obesity / complications ; Retrospective Studies ; Trachea*
Keywords
Body mass index ; Intratracheal intubation ; Obesity ; One-lung ventilation ; Patient positioning ; Retrospective studies
Abstract
Background: Double-lumen endobronchial tube (DLT) displacement, defined as migration of the DLT > 15 mm from optimal position, may threaten patient safety. Lateral decubitus positioning (LDP) of the patient can induce DLT displacement; however, little is known regarding the predictors for DLT displacement after this maneuver. Obesity may further aggravate DLT displacement by distorting mediastinal anatomy, but no comprehensive data exist concerning the impact of obesity on DLT displacement after LDP. Therefore, we evaluated the predictive value of preoperative risk factors, including obesity, for DLT displacement after LDP in patients who underwent pulmonary resection.

Methods: Data of patients who underwent pulmonary resection between July 2020 and July 2021 were retrospectively reviewed. Age, sex, height, weight, body mass index, left main bronchus diameter, DLT size, lateral decubitus direction, DLT depth, patient height divided by the DLT depths in supine and lateral decubitus positions (H/Dsupine and H/Dlateral, respectively), and extent of DLT dislocation were assessed. Logistic regression analysis identified risk factors, and the optimal cutoff values for continuous variables were determined using receiver operating characteristic curve analysis.

Results: Data from 428 patients were analyzed. DLT displacement was observed in 52 patients (12.1%). Obesity and H/Dsupine were independent predictors for DLT displacement after LDP (odds ratio [OR]: 5.69, 95% CI [2.89, 11.23], P < 0.001 and OR: 8.28, 95% CI [2.92, 23.48], P < 0.001, respectively).

Conclusions: Obesity was significantly associated with DLT displacement after LDP. Pre-emptively advancing the DLT from its optimal position before LDP may be advantageous in patients with obesity.
Files in This Item:
T202303177.pdf Download
DOI
10.4097/kja.22493
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Min Soo(김민수) ORCID logo https://orcid.org/0000-0001-8760-4568
Oh, Young Jun(오영준) ORCID logo https://orcid.org/0000-0002-6258-5695
Lee, Kyuho(이규호)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/195414
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