Original contributionTracheal width and left double-lumen tube size: a formula to estimate left-bronchial width
Introduction
The wrong-sized double-lumen tube (DLT) can damage an airway or compromise the surgical procedure. We directly measured left bronchial width (LBW) from chest radiographs and then tried to identify which patient parameter(s) best predicted LBW. Once LBW is known, then a left-DLT whose bronchial component fits that bronchus can be selected.
Section snippets
Materials and methods
With the permission of the Stanford University Medical Center’s Human Subjects Committee, we enrolled in the study 321 consecutive patients scheduled for thoracic surgery. Of the 321 patients, 192 patients (60%; 112 males, 80 females) had available a posterior-anterior chest radiograph in which both the trachea and left-bronchial air columns were clearly visible. Only those 192 patients were included in the data analysis.
The width of the trachea (TW, mm) at the level of the clavicles was
Results
Table 1 shows the demographic data for the patients.
In the univariate correlation analysis (Table 2), LBW was positively associated with height, age, and TW in males, and with height and TW in females. In the multivariate regression analysis, TW was the only factor that independently predicted LBW (Fig. 1). Sex, weight, height, and age did not contribute to a further reduction in the variance of LBW.
Based on chest radiographical measurement, the equation that best predicts LBW for both sexes
Discussion
Choice of DLT size is important. A small tube is more likely to be advanced further into the bronchus where it can obstruct the upper lobe [1]. The lumens of smaller tubes offer greater resistance to airflow [2], [3] and generate higher levels of auto-PEEP during 1-lung ventilation [4]. A tube that is too large or too small can damage the airway.
The most accurate way to choose a DLT is to directly measure LBW. If LBW and the dimensions of the DLT are known, then the largest tube that can safely
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