Double-Lumen Endotracheal Tube Placement
Conditions
Keywords
Double-Lumen Endotracheal Tube, Head Rotation, One-Lung Ventilation, Fiberoptic Bronchoscopy, Airway Management
Brief summary
This study evaluated how simple external airway maneuvers affect the alignment of the left main bronchus during placement of a left-sided double-lumen endotracheal tube. Adults undergoing elective thoracic surgery requiring one-lung ventilation were enrolled. During double-lumen tube placement, a fiberoptic bronchoscope was used to continuously view the airway. Each participant underwent three sequential maneuvers: rightward displacement of the trachea, turning the head 45 degrees to the right, and turning the head 45 degrees to the left. The investigators measured how far the opening of the left main bronchus moved on the bronchoscopic image and whether it crossed the center of the image. The purpose of the study was to determine how these maneuvers change airway alignment and whether they may help guide a left-sided double-lumen tube toward the left main bronchus.
Interventions
PROCEDURERight Tracheal Displacement
A lateral force was applied externally at the left cricothyroid level to displace the trachea toward the right. The force was increased until maximal bronchoscopic displacement was observed. Peak applied force was recorded using a digital force gauge. Bronchoscopic alignment and horizontal displacement of the left main bronchus were assessed during the maneuver.
PROCEDURERight Head Turn Maneuver
The participant's head was rotated 45° to the right from the neutral position. Bronchoscopic alignment and horizontal displacement of the left main bronchus were assessed during the maneuver. The head was subsequently returned to the neutral position.
PROCEDURELeft Head Turn Maneuver
The participant's head was rotated 45° to the left from the neutral position. Bronchoscopic alignment and horizontal displacement of the left main bronchus were assessed during the maneuver. The head was subsequently returned to the neutral position.
Sponsors
Taipei Veterans General Hospital, Taiwan
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
BASIC_SCIENCE
Masking
NONE
Intervention model description
All participants underwent the same three airway maneuvers in a predefined sequence: right tracheal displacement, 45° right head turn, and 45° left head turn. The airway and head position were returned to neutral before each subsequent maneuver. Bronchoscopic alignment and horizontal displacement of the left main bronchus were assessed during each maneuver.
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
* Patients scheduled for elective thoracic surgery requiring lung isolation with a left-sided double-lumen endotracheal tube * American Society of Anesthesiologists (ASA) physical status I-III * Provided written informed consent
Exclusion criteria
* Known severe cervical spine pathology or cervical instability * History of cervical spine surgery * Significant anatomical abnormalities of the upper airway * Head or neck malignancy or obstructing airway neoplasm * Presence of a tracheostomy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Midline Crossing of the Left Main Bronchus | During the airway maneuver, immediately after each maneuver was applied | Midline crossing was defined as a change in the position of the left main bronchus from the left side to the right side of the midline of the bronchoscopic image following each airway maneuver. The position of the left main bronchus was assessed using real-time fiberoptic bronchoscopy with the bronchoscope maintained 2 cm proximal to the carina. Midline crossing was recorded as a binary outcome (yes/no) for each maneuver. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Relative Horizontal Displacement of the Left Main Bronchus | During the airway maneuver, immediately after each maneuver was applied | Relative horizontal displacement was defined as the difference in the horizontal position of the left main bronchus before and during each airway maneuver, expressed as a percentage (Δ%) of the total width of the bronchoscopic image. The right edge of the left main bronchus was used as the reference point. Positive values indicated rightward displacement and negative values indicated leftward displacement. Measurements were obtained from bronchoscopic images with the bronchoscope maintained 2 cm proximal to the carina. |
Countries
Taiwan
Contacts
PRINCIPAL_INVESTIGATORChien-Kun Ting, MD, PhD
Taipei Veterans General Hospital, Taiwan
Outcome results
None listed