Study On Positioning Of Left-sided Double-lumen Endobronchial Tubes Properly By Withdrawing The Catheter

Objective: To evaluation the feasibility of a new approach to positioning of a left-sided double-lumen endobronchial tube properly: under the premise of the tube size matches for the left mainstem bronchial diameter ,withdrawing the tube after it was inserted into the left bronchus and the resistance was felt, positioning the tube correctly without the aid of any instrument.Methods: one hundred ASAⅠ～Ⅱpatients undergoing thoracic surgery and whole-lung lavage who needed one -lung ventilation with left-sided double-lumen tubes were enrolled in the study and randomly divided into two groups . To choose the size of a left double-lumen endobronchial tube based on the measurement of left mainstem bronchial diameter according to preoperative chest computed tomographic scan.The left-sided double-lumen endobronchial tubes were placed with the new approach of'withdrawing the tube'in group A(n=50),and the tubes were positioned according to auscultation in group B(n=50), the depth of tubes placement were recorded respectively. Then the position of the tubes were readjusted with a fiberotic bronchoscope , the new depth of the tubes recorded again.Recording intubation time in group A and B respectively, recording the airway mucosal injury . Observe the suitability of the tubes for patients . Seek the relationship between body height and depth of left-sided double-lumen endobronchial tubes.Result: In group A, fiberotic bronchoscope revealed : the ratio of satisfied positioning was 92%, and malpositioning was 8%, intubation time was 28±2.3 seconds, the incidence of airway mucosal injury was 32%. In group B, the ratio of satisfied positioning was 56%, and malpositioning was 44%, intubation time was 139.8±12.1 seconds, the incidence of airway mucosal injury was 54%. Comparison of all these parameters in group A with group B, they were statistically significant(P<0.05 or P<0.01 ). The left double-lumen tube size are all suitable for patients ,the insertion success was 100%. There is a high possitive correlation between the depth of Sheridan? left-sided double-lumen endobronchial tube and body heigh(tP<0.01).Conclusion: The approach of positioning left-sided double- lumen endobronchial tube properly by'withdrawing the catheter'is significantly better than placement of the tubes using only auscultation, it is effective and safe,which is worthy of extending in clinical application .Chest CT scan measurement of left bronchial diameter can successfully guide the choice of left double-lumen tube size for an individual patient.There is a high possitive correlation between the depth of Sheridan? left-sided double-lumen endobronchial tube and body height.