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. 2024 Apr 12;24(1):142.
doi: 10.1186/s12871-024-02525-6.

A novel combined approach to placement of a double lumen endobronchial tube using a video laryngoscope and fiberoptic bronchoscope: a retrospective chart review

Luiz Maracaja  1 , Alexandra Coffield  2 , L Daniela Smith  2 , J David Bradshaw  2 , Amit K Saha  2 , Christopher S McLauglin  2 , T Wesley Templeton  3
Affiliations

A novel combined approach to placement of a double lumen endobronchial tube using a video laryngoscope and fiberoptic bronchoscope: a retrospective chart review

Luiz Maracaja et al. BMC Anesthesiol. .

Abstract

Background: The objective of this study was to evaluate a modern combined video laryngoscopy and flexible fiberoptic bronchoscope approach to placement of a double lumen endobronchial tube and further characterize potential strengths and weaknesses of this approach.

Methods: Retrospective chart review was conducted at our single institution, academic medical center, tertiary-care hospital. Patients aged 18 years of age or older were evaluated who underwent thoracic surgery and one-lung ventilation with placement of a double lumen endobronchial tube using a novel combined video laryngoscopy and flexible fiberoptic bronchoscope approach. No interventions were performed.

Results: Demographics and induction and intubation documentation were reviewed for 21 patients who underwent thoracic surgery and one-lung ventilation with placement of a double lumen endobronchial tube using a novel combined video laryngoscopy and flexible fiberoptic bronchoscope approach. First pass success using the combined approach was 86% (18/21). The five patients with an anticipated difficult airway had successful double lumen endobronchial tube placement on the first attempt. There were no instances of desaturation during double lumen endobronchial tube placement. No airway complications related to double lumen endobronchial tube placement were recorded.

Conclusion: Use of a combined approach employing video laryngoscopy and a flexible fiberoptic bronchoscope may represent a reliable alternative approach to placement of double lumen endobronchial tubes.

Keywords: Airway management; Double lumen endobronchial tube; One-lung ventilation; Thoracic anesthesia.

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Conflict of interest statement

Founder of Pneuomocyte LLC. LM is now a paid consultant for Verathon the manufacturer of the Glidescope. He began his role as a consultant after the conclusion of this study and did not receive any funding during the time in which these cases occurred. LM has not previously been a consultant for Verathon. No other listed authors have any relevant competing interests.

Figures

Fig. 1
Fig. 1
(A) Left sided double lumen endobronchial tube. (B) Left-sided, double lumen endobronchial tube with approximate 90 degree bend at the distal end
Fig. 2
Fig. 2
(A) Double lumen endobronchial tube is inserted into the mouth in the midline and then shifted to the right side of the mouth. (B) A video laryngoscope is inserted. (C) The bronchial lumen and bronchial cuff are advanced into the glottis. (D) Once below the vocal cords the stylet is removed from the double lumen endobronchial tube. (E) A fiberoptic scope is introduced into the bronchial lumen and the trachea is imaged. (F) The fiberoptic bronchoscope is advanced into the left mainstem bronchus. (G) The double lumen endobronchial tube is advanced over the fiberoptic scope and the bronchial lumen and cuff are advanced into the left mainstem bronchus. (H) The fiberoptic scope is inserted into the tracheal lumen and final adjustment to the depth of the double lumen endobronchial tube is performed so that a rim of the bronchial cuff can be seen at the carina
See this image and copyright information in PMC

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