Eldawlatly Abdelazeem A, El Tahan Mohamed R, Kanchi Naveed U, Al Qatari Ahmad, Ahmad Abdulaziz E
Anaesthesia Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Department of Anaesthesia, College of Medicine, Imam Abdulrahman Bin Faisal University, Damman, Saudi Arabia.
Anaesth Intensive Care. 2020 Sep;48(5):354-357. doi: 10.1177/0310057X20946051. Epub 2020 Oct 4.
The insertion depth of the left-sided double-lumen tube needs careful positioning and bronchoscopic confirmation. Several formulae based on body height have been used for estimating the optimal insertion depth of a left-sided double-lumen tube. We conducted this prospective study to test the hypothesis that our earlier developed height-based formula (0.25 × body height) could predict the accurate insertion depth of a left-sided double-lumen tube. After obtaining ethical approval, 66 patients who underwent thoracic surgery were included. A left-sided double-lumen tube was advanced blindly to the predicted depth of insertion calculated using our formula. The optimal position of the left-sided double-lumen tube was confirmed using a fibreoptic bronchoscope. The primary outcome was the percentage of tubes placed in the optimal position without the need for further adjustments. The secondary outcomes included the need for bronchoscopic adjustments and the final correct insertion depth of the left-sided double-lumen tube. The formula resulted in an optimum position of the left-sided double-lumen tube without further adjustments in 45 patients (70%) (95% confidence interval 58%-80%). The left-sided double-lumen tube was withdrawn or advanced in 18.2% and 12.1%, respectively, to achieve the optimal insertion depth. We found that our formula provided satisfactory positioning in about 70% of patients and that in the remaining patients, the adjustments required to achieve satisfactory positioning under fibreoptic bronchoscope guidance were minimal. Nevertheless, as it is not possible to predict which patients will have a satisfactory tube position, bronchoscopic confirmation for the final positioning is still required.
左侧双腔管的插入深度需要仔细定位并通过支气管镜确认。基于身高的几个公式已被用于估计左侧双腔管的最佳插入深度。我们进行了这项前瞻性研究，以检验我们早期开发的基于身高的公式（0.25×身高）能否预测左侧双腔管的准确插入深度这一假设。获得伦理批准后，纳入了66例接受胸外科手术的患者。将左侧双腔管盲目推进至使用我们的公式计算出的预测插入深度。使用纤维支气管镜确认左侧双腔管的最佳位置。主要结局是无需进一步调整即可置于最佳位置的导管百分比。次要结局包括是否需要支气管镜调整以及左侧双腔管的最终正确插入深度。该公式使45例患者（70%）（95%置信区间58%-80%）的左侧双腔管处于最佳位置而无需进一步调整。分别有18.2%和12.1%的患者将左侧双腔管拔出或推进以达到最佳插入深度。我们发现我们的公式在约70%的患者中提供了满意的定位，而在其余患者中，在纤维支气管镜引导下实现满意定位所需的调整极少。然而，由于无法预测哪些患者的导管位置会令人满意，最终定位仍需要支气管镜确认。
