Faculty Collaboration Database

Performance comparison of right- and left-sided double-lumen tubes among infrequent users. J Cardiothorac Vasc Anesth 2010 Aug;24(4):598-601

Date

11/28/2009

Pubmed ID

19942453

DOI

10.1053/j.jvca.2009.09.007

Scopus ID

2-s2.0-77955710190 (requires institutional sign-in at Scopus site)   20 Citations

Abstract

OBJECTIVE: To compare performance of right- versus left-sided double-lumen tubes (DLTs) among infrequent users by evaluating the incidence and severity of hypoxemia, hypercapnia, and high airway pressures.

DESIGN: A retrospective, cohort study.

SETTING: A university hospital.

PARTICIPANTS: Ninety-eight patients undergoing left-sided DLT placement (53.9 +/- 21.2 years old) and 98 patients undergoing right-sided DLT placement (62.3 +/- 20.6 years old). Cases performed by thoracic anesthesia specialists were excluded.

INTERVENTIONS: The authors retrospectively reviewed electronic anesthetic records from a 2-year period to determine the incidence and severity of hypoxia (SpO(2) < 90%), hypercapnia (end-tidal carbon dioxide > 45 mmHg) and high airway pressures (peak inspiratory pressure >35 cmH(2)O) during one-lung ventilation via right and left DLTs.

MEASUREMENTS AND MAIN RESULTS: Right-sided (n = 98) DLTs were almost exclusively used on the side contralateral to surgery by infrequent users, whereas left-sided (n = 98) DLTs were used for ipsilateral surgery one third of the time. Hypoxia lasted longer in left versus right DLTs, but the frequency of hypoxia was the same for each tube type among infrequent users. Hypercapnia and high airway pressures occurred more frequently with left-sided DLTs.

CONCLUSIONS: Left-sided DLTs are perceived to be safer because they may be less prone to malpositioning during lung isolation. However, the supposition that left-sided DLTs are safer than right-sided DLTs when intraoperative hypoxia, hypercapnia, and high airway pressures are used as criteria, even when these tubes are used by infrequent users, is not supported by the data.

Author List

Ehrenfeld JM, Mulvoy W, Sandberg WS

Author

Jesse Ehrenfeld MD, MPH Sr Associate Dean, Director, Professor in the Advancing a Healthier Wisconsin Endowment department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aged, 80 and over
Bronchoscopy
Cohort Studies
Equipment Design
Female
Fiber Optic Technology
Humans
Hypercapnia
Hypoxia
Internship and Residency
Intubation, Intratracheal
Male
Medical Staff, Hospital
Middle Aged
Retrospective Studies
Time Factors