Original contribution
Can ultrasound be useful for predicting the size of a left double-lumen bronchial tube? Tracheal width as measured by ultrasonography versus computed tomography

https://doi.org/10.1016/j.jclinane.2007.11.002Get rights and content

Abstract

Study Objective

To correlate tracheal width as measured by ultrasound with width measured by computed tomography (CT), and to evaluate the possible role of ultrasound in the selection of the proper size of left-sided double-lumen endotracheal tubes (LDLTs).

Design

Two independent, prospective, observational clinical studies (Study 1 and Study 2).

Setting

University hospital.

Patients

Study 1 included 25 patients and Study 2 included 20 adult thoracic surgery patients who required a LDLT during anesthesia.

Interventions and Measurements

In Study 1, CT measurements of tracheal width were made at the coronary plane 0.5 cm above the sternoclavicular joint; CT measurements of the left main bronchus diameter were made 1 cm below the carina. Ultrasound measurement of tracheal width was performed just above the sternoclavicular joint in the transversal section. In Study 2, patients' tracheas were intubated with a LDLT based on ultrasound measurements. The frequencies of incorrect selections of LDLT and unsatisfactory lung collapse were analyzed.

Main Results

There was a strong correlation between tracheal width as measured by ultrasound and tracheal width (r = 0.882, P < 0.001) and left main bronchus width (r = 0.832, P < 0.001) as measured by CT. In 5 cases (25%), the incorrect LDLT by ultrasound was selected; and one (5%) was found to have an unsatisfactory lung collapse.

Conclusion

Measurement of the outer tracheal width by ultrasound can be a useful method for predicting the diameter of left main bronchus and for selecting a LDLT.

Introduction

Double-lumen endobronchial tubes are used to isolate and/or to collapse the lungs selectively during thoracic procedures. A left-sided double-lumen tube (LDLT) is preferred for both right- and left-sided procedures, and it can be used successfully in more than 98% of patients [1]. An LDLT should be positioned accurately because a misplaced or an improperly used tube can jeopardize the procedure or injure the patient. One of the most important steps in avoiding complications associated with endotracheal tubes (ETTs) is choosing an appropriate-sized LDLT. If the ETT is too large, it will cause cuff overinflation and serious tracheal trauma. If the ETT is too small, it will be easily dislocated with malposition [2], [3], [4]. Brodsky et al found a direct correlation between tracheal and bronchial widths, and that measurement of the tracheal width from a chest radiograph was a useful guide in determining which LDLT size to select [5], [6], [7]. The trachea, because of its relatively superficial position, is easily visible by ultrasonography [8]. Recently, we and others described ultrasonography as a useful supporting method for percutaneous dilatational tracheostomy placement, especially in difficult cases [9], [10]. One of the advantages of ultrasonography included preprocedural measurement of the tracheal transversal outer diameter (OD) so that an adequate size of tracheostomy tube can be determined (Fig. 1) [11]. We hypothesized that tracheal width as measured by ultrasonography correlated with tracheal width that was measured by multislice computed tomography (CT), and that ultrasonography can also be a useful method for predicting the size of an LDLT.

Section snippets

Materials and methods

The investigation was designed in two independent, prospective, observational clinical studies (Study 1 and Study 2), with two groups of elective adult thoracic surgery patients. All patients were informed preoperatively of the research and provided their informed, written consent to participate. The protocol was approved by the Ethical University Board of University Hospital Rijeka.

Results

Patients from Study 1 and Study 2 did not differ with regard to age (61 ± 13.4 vs 58 ± 11.6 yrs), gender (male 56% vs male 60%), or BMI (25 ± 3.3 vs 26 ± 2.6).

Discussion

Various methods have been proposed to determine proper LDLT size. Brodsky et al showed that direct measurement of tracheal diameter at the interclavicular plane from the preoperative conventional anterior-posterior chest radiograph can be used as a guide to predict the correct LDLT size [5], [7]. However, Chow et al found that the measurement of tracheal diameter from a chest radiograph is less reliable in patients who are of small stature [13]. They and others suggested CT as a possible

Acknowledgment

The authors thank Zeljko Bosnjak, PhD, for his assistance.

References (19)

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