Annals of Cardiac Anaesthesia Annals of Cardiac Anaesthesia Annals of Cardiac Anaesthesia
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Table of Contents
Year : 2021  |  Volume : 24  |  Issue : 1  |  Page : 47-48
Practice patterns of left-sided double-lumen tube: Does It match recommendation from literature

Department of Anaesthesia, SGPGI, Lucknow, Uttar Pradesh, India

Click here for correspondence address and email

Date of Submission10-Aug-2018
Date of Acceptance05-Sep-2018
Date of Web Publication22-Jan-2021

How to cite this article:
Rastogi A. Practice patterns of left-sided double-lumen tube: Does It match recommendation from literature. Ann Card Anaesth 2021;24:47-8

How to cite this URL:
Rastogi A. Practice patterns of left-sided double-lumen tube: Does It match recommendation from literature. Ann Card Anaesth [serial online] 2021 [cited 2022 Jan 25];24:47-8. Available from:

Left-sided double-lumen tubes (LDLTs) are most commonly used DLTs in almost all single-lung procedures, with few exceptions of distorted anatomy or left-sided procedures. Choosing an appropriate size of LDLT is utmost for successful one-lung ventilation, which is required for thoracic, cardiac, neurological, and various other surgical procedures. An adequate-sized double-lumen fits the bronchus with minimal volume of air in bronchial cuff so that bronchial mucosa is minimally or not compromised at all. Proper-sized DLT not only reduces airway pressure but also helps in proper pulmonary suctioning and faster lung collapse and fiberoptic bronchoscopy.

There is abundance of medical literature for deciding for size of DLT, but studies for Indian population are still lacking. Various parameters have been evaluated for deciding the size of DLT such as age, sex, height, weight, and body mass index. With the advent of time, various radiological parameters have also been undertaken to decide upon the size of DLT such as diameter of cricoid ring or transverse diameter of cricoid cartilage, diameter of left mainstem bronchus, and tracheal width taken by computed tomography (CT) scan or ultrasonography (USG) modalities.

Shiqing et al. studied Asian adult patients and measured diameters of cricoid ring and left main bronchus and found that the “best fit” size of a DLT should be decided by a combination of diameters of the cricoid ring and the left main bronchus.[1]

Alan et al. have done two independent, prospective, observational clinical studies to correlate tracheal width as measured by ultrasound with width as measured by CT scan and also evaluated the possible role of USG in the selection of the proper size of LDLT. They found that there was a strong correlation between tracheal width as measured by ultrasound and tracheal width and left main bronchus width as measured by CT scan. They also found that measurement of the outer tracheal width by ultrasound could also be a useful method for predicting the diameter of left main bronchus and for selecting a proper-sized LDLT.[2]

Sato et al. retrospectively studied anesthesia records of Japanese women aged ≤20 years who underwent thoracic surgery with 32-Fr or 35-Fr DLT and found that along with left mainstem bronchial diameter (LMBD), transverse diameters of cricoid cartilages based on CT scans or ultrasound may help us in selecting the appropriate size of LDLT.[3]

Ideris et al. retrospectively reviewed 179 patients who were intubated with an LDLT and also studied their posterior-anterior view of digital chest radiograph for tracheal and left main bronchus diameter measurements. She found that there was a poor correlation between DLT size with height, weight, TD, or LMBD for both genders. They also found that only in about half the patients for both genders used a DLT size which was as per their height range and most of the remaining patients required a downsizing of DLTs.[4] Kar et al. did a single-center, prospective observational study of 41 patients requiring single-lung ventilation with LDLT with choice of size of LDLT entirely on the discretion of anesthesiologist in charge. They have collected data for tracheal diameter (TD), LMBD, height, weight, age, sex, and amount of air used in the tracheal and bronchial cuff and found that although there is a poor correlation between DLT size and height, TD, and LMBD, the overall intraoperative outcome and lung isolation were good.[5]

The clinical acumen of anesthetist along with correlation of anthropometric data and various radiological parameters as described in various studies can be combined for choosing an adequate size of LDLT.

DLT manufactured by different companies also have subtle differences in diameters though they have same sizes. To prevent this problem international standardization of tube specifications must also be made uniform. In conclusion, no guidelines and parameters are still concrete enough to correctly predict the size of a DLT.

   References Top

Shiqing L, Wenxu Q, Jin Z, Youjing D. The combination of diameters of cricoid ring and left main bronchus for selecting the “Best fit” double-lumen tube. J Cardiothorac Vasc Anesth 2018;32:869-76.  Back to cited text no. 1
Sustic A, Miletic D, Protic A, Ivancic A, Cicvaric T. Can ultrasound be useful for predicting the size of a left double-lumen bronchial tube? Tracheal width as measured by ultrasonography versus computed tomography. J Clin Anesth 2008;20:247-52.  Back to cited text no. 2
Sato M, Kayashima K. Difficulty in inserting left double-lumen endobronchial tubes at the cricoid level in small-statured women: A retrospective study. Indian J Anaesth 2017;61:393-7.  Back to cited text no. 3
[PUBMED]  [Full text]  
Ideris SS, Che Hassan MR, Abdul Rahman MR, Ooi JS. Selection of an appropriate left-sided double-lumen tube size for one-lung ventilation among Asians. Ann Card Anaesth 2017;20:28-32.  Back to cited text no. 4
[PUBMED]  [Full text]  
Kar P, Pathy A, Sundar AS, Gopinath R, Moningi S. Practice patterns of left-sided double-lumen tube: Does it match recommendation from literature-A single-centre observational pilot study. Ann Card Anaesth 2019;22:51-5.  Back to cited text no. 5
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Correspondence Address:
Amit Rastogi
Department of Anaesthesia, SGPGI, Lucknow, Uttar Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/aca.ACA_165_18

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