From the Departments of Anesthesiology.
Thoracic Surgery, Shengjing Hospital of China Medical University, Shenyang, China.
Anesth Analg. 2020 Nov;131(5):1485-1490. doi: 10.1213/ANE.0000000000004669.
The double-lumen tubes (DLTs) are the most widely used devices to provide perioperative lung isolation. Airway rupture is a rare but life-threatening complication of DLTs. The primary aim of this review was to collect all cases reported in the literature about airway rupture caused by DLTs and to describe the reported possible contributors, diagnosis, treatment, and outcomes of this complication. Another aim of this review was to assess the possible factors associated with mortality after airway rupture by DLTs. A comprehensive literature search for all cases of airway rupture caused by DLTs was performed in the PubMed, EMBASE, Ovid, Wanfang Database, and CNKI. The extracted data included age, sex, height, weight, type of operation, type and size of DLT, site of airway rupture, possible contributors, clinical presentation, diagnosis timing, treatment, and outcome. We included 105 single case reports and 22 case series with a total number of 187 patients. Most of the ruptures were in the trachea (n = 98, 52.4%) and left main bronchus (n = 70, 37.4%). The common possible contributors include use of a stylet, cuff overdistention, multiple attempts to adjust the position of a DLT, difficult intubation, and use of an oversized DLT. Most of the airway ruptures were diagnosed intraoperatively (n = 138, 82.7%). Pneumomediastinum, air leakage, hypoxemia, and subcutaneous emphysema were the common clinical manifestations. Most patients were treated with surgical repair (n = 147, 78.6%). The mortality of the patients with airway rupture by DLTs was 8.8%. Age, sex, site of rupture, diagnosis timing, and method of treatment were not found to be associated with mortality.
双腔管（DLT）是用于提供围手术期肺隔离的最广泛使用的装置。气道破裂是 DLT 的一种罕见但危及生命的并发症。本综述的主要目的是收集文献中所有关于 DLT 引起的气道破裂的病例，并描述该并发症的报告可能诱因、诊断、治疗和结果。本综述的另一个目的是评估由 DLT 引起的气道破裂后与死亡率相关的可能因素。在 PubMed、EMBASE、Ovid、万方数据库和中国知网中对所有由 DLT 引起的气道破裂的病例进行了全面的文献检索。提取的数据包括年龄、性别、身高、体重、手术类型、DLT 的类型和大小、气道破裂部位、可能诱因、临床表现、诊断时机、治疗和结果。我们纳入了 105 例单独的病例报告和 22 例病例系列，共涉及 187 例患者。大多数破裂发生在气管（n = 98，52.4%）和左主支气管（n = 70，37.4%）。常见的可能诱因包括使用芯丝、套囊过度充气、多次尝试调整 DLT 位置、插管困难和使用过大的 DLT。大多数气道破裂是在术中诊断的（n = 138，82.7%）。纵隔气肿、漏气、低氧血症和皮下气肿是常见的临床表现。大多数患者接受了手术修复（n = 147，78.6%）。由 DLT 引起的气道破裂患者的死亡率为 8.8%。年龄、性别、破裂部位、诊断时机和治疗方法与死亡率无关。
