Comparison of Ultrasound, CT, and Classical Methods for Selecting Sizes and Placement of Left-Sided Double-Lumen Tubes
NCT ID: NCT06731517
Last Updated: 2024-12-12
Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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COMPLETED
150 participants
OBSERVATIONAL
2023-10-20
2024-03-25
Brief Summary
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Detailed Description
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Choosing the right DLT size depends heavily on patient-specific factors. Undersized DLTs can cause airway injuries, increased resistance, and displacement, while oversized DLTs are linked to postoperative issues like sore throat and difficult intubation. Despite this, no universal criterion exists for DLT size selection. Traditional methods rely on height and gender, but weak correlations with airway size often lead to improper choices, especially in shorter individuals.
Imaging techniques like chest X-rays, Computed Tomography (CT), and ultrasonography (USG) offer a more precise approach to airway measurements for DLT selection. USG is especially advantageous due to its accessibility, speed, and ease of use in operating rooms and emergencies. To improve the accuracy and ease of DLT size selection and placement, investigators aimed to compare anatomical measurements from USG and CT with traditional methods.
Conditions
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Keywords
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Study Design
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COHORT
PROSPECTIVE
Study Groups
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Classical group
In the classical group, Double Lumen Tube selection was based on gender and height. For males, a 41 F tube was chosen if height \>170 cm, and a 39 F tube if height ≤170 cm. For females, a 37 F tube was used if height \>160 cm, and a 35 F tube if height ≤160 cm. The depth was determined using the formula: 12 + (patient height/10). The calculated depth was marked on the DLT, and after intubation, the mark was positioned at the level of the upper teeth.
intubation
Double-Lumen Tube Intubation
Ultrasonography group
In the Ultrasonography (USG) group, Double Lumen Tube selection was based on the transverse cricoid cartilage diameter measured preoperatively using ultrasound. A 41 F tube was selected if the cricoid diameter was ≥18 mm, 39 F for 16-17.9 mm, 37 F for 15-15.9 mm, 35 F for 13-14.9 mm, and 32 F for \<13 mm (Table 5) (5). To determine placement depth, the distance between the vocal cords and the Louis angle was measured (the Louis angle was used as a guide as it anatomically aligns with the carina). The position of the vocal cords was identified using USG. The measured length was marked starting from the bronchial cuff line, and this mark was positioned at the level of the vocal cords during intubation.
intubation
Double-Lumen Tube Intubation
Computed Tomography
In the Computed Tomography (CT) group, Double Lumen Tube selection was based on CT measurements. Radiologists measured the cricoid diameter and the distance between the carina and the vocal cords. A 41 F tube was selected if the cricoid diameter was ≥18 mm, 39 F for 16-17.9 mm, 37 F for 15-15.9 mm, 35 F for 13-14.9 mm, and 32 F for \<13 mm (Table 5) (5). The calculated depth was marked starting from the bronchial cuff line, and this mark was positioned at the level of the vocal cords during intubation.
intubation
Double-Lumen Tube Intubation
Interventions
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intubation
Double-Lumen Tube Intubation
Eligibility Criteria
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Inclusion Criteria
* American Society of Anesthesiologists (ASA) risk score of 1-2-3,
* Patients who are literate and able to provide informed consent
Exclusion Criteria
* Criteria for difficult intubation,
* Difficulty in mouth opening, small jaw deformities,
* Abnormal cricoid cartilage appearance,
* A history of laryngeal or neck surgery,
* Preoperative throat pain and hoarseness,
* Tumors and deformities in the main airway
18 Years
80 Years
ALL
Yes
Sponsors
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Ankara City Hospital Bilkent
OTHER
Responsible Party
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Principal Investigators
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SUMRU ŞEKERCİ, PROF
Role: PRINCIPAL_INVESTIGATOR
Ankara City Hospital Bilkent
Locations
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Ankara Bilkent City Hospital
Ankara, ÇANKAYA, Turkey (Türkiye)
Countries
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References
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Zhang X, Wang DX, Wei JQ, Liu H, Hu SP. Recent advances in double-lumen tube malposition in thoracic surgery: A bibliometric analysis and narrative literature review. Front Med (Lausanne). 2022 Dec 14;9:1071254. doi: 10.3389/fmed.2022.1071254. eCollection 2022.
Chang TR, Yuan MK, Pan SF, Chuang CC, So EC. Double-Lumen Endotracheal Tube-Predicting Insertion Depth and Tube Size Based on Patient's Chest X-ray Image Data and 4 Other Body Parameters. Diagnostics (Basel). 2022 Dec 14;12(12):3162. doi: 10.3390/diagnostics12123162.
Woo JH, Cho S, Kim YJ, Kim DY, Choi Y, Lee JW. Depth of double-lumen endobronchial tube: a comparison between real practice and clinical recommendations using height-based formulae. Anesth Pain Med (Seoul). 2023 Jan;18(1):37-45. doi: 10.17085/apm.22214. Epub 2023 Jan 10.
Shiqing L, Wenxu Q, Yuqiang M, Youjing D. Predicting the Size of a Left Double-Lumen Tube for Asian Women Based on the Combination of the Diameters of the Cricoid Ring and Left Main Bronchus: A Randomized, Prospective, Controlled Trial. Anesth Analg. 2020 Mar;130(3):762-768. doi: 10.1213/ANE.0000000000003839.
Brodsky JB, Macario A, Mark JB. Tracheal diameter predicts double-lumen tube size: a method for selecting left double-lumen tubes. Anesth Analg. 1996 Apr;82(4):861-4. doi: 10.1097/00000539-199604000-00032. No abstract available.
Eldawlatly AA. Double lumen tube: Size and insertion depth. Saudi J Anaesth. 2021 Jul-Sep;15(3):280-282. doi: 10.4103/sja.sja_192_21. Epub 2021 Jun 19.
Liu Z, Zhao L, Jia Q, Yang X, Liang SJ, He W. Chest Computed Tomography Image for Accurately Predicting the Optimal Insertion Depth of Left-Sided Double-Lumen Tube. J Cardiothorac Vasc Anesth. 2018 Apr;32(2):855-859. doi: 10.1053/j.jvca.2017.09.025. Epub 2017 Sep 20.
Zhang C, Qin X, Zhou W, He S, Liu A, Zhang Y, Dai Z, Yin J. Prediction of Left Double-Lumen Tube Size by Measurement of Cricoid Cartilage Transverse Diameter by Ultrasound and CT Multi-Planar Reconstruction. Front Med (Lausanne). 2021 Jun 16;8:657612. doi: 10.3389/fmed.2021.657612. eCollection 2021.
Other Identifiers
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ANKCHBILKENT-ANES-SO-01
Identifier Type: -
Identifier Source: org_study_id