Double-lumen Tube Position Confirmation with Fiberoptic Bronchoscope after Turning Patients into Lateral Position: Is It Necessary?

Seyed Mohammad Mireskandari; Golnaz Darabi; Shahab Rafieian; Afshin Jafarzadeh; Kasra Karvandian; Jalil Makarem

doi:10.18502/jimc.v5i1.9586

Seyed Mohammad Mireskandari Department of Anesthesia & Critical Care, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Golnaz Darabi Tehran University of Medical Sciences, Tehran, Iran
Shahab Rafieian Department of Thoracic Surgery, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Afshin Jafarzadeh Department of Anesthesia & Critical Care, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Kasra Karvandian Department of Anesthesia & Critical Care, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Jalil Makarem Department of Anesthesia & Critical Care, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/jimc.v5i1.9586

Keywords: Auscultation, Double-lumen tube, Fiberoptic bron- choscopy, Lateral decubitus, Thoracic surgery

Abstract

Background: Our goal was to compare two common methods including auscultation and Fiber-Optic Bronchoscopy (FOB) in confirming the correct placement of Double-Lumen Tube (DLT).

Methods: Seventy six patients were enrolled. After DLT insertion, clinical verification was made by auscultation, then FOB was applied. At lateral decubitus, the position of DLT was rechecked by auscultation, and then by FOB. The incorrect position including malposition and misplacement were compared between two routine methods of auscultation and FOB.

Results: After blind intubation, 21.1% of DLTs were considered to be in an incorrect position. Meanwhile, FOB showed that 46.1% of DLTs were not placed correctly. Among all the patients, 53.9% of DLTs were in the optimal position. Misplacement was diagnosed in 35.5% and malposition in 10.5% of the patients. After positioning to the lateral decubitus, using auscultation, we found that 5.3% of tubes were dislocated, but according to FOB, it was 10.5%. The agreement coefficient between auscultation and FOB was 0.42 in the supine position and 0.64 in lateral position.

Conclusion: Our results showed that although FOB needs more time to check the position of DLT, it should be used to confirm the exact position of DLT.