Changes in the Bronchial Cuff Pressure of Left-Sided Double-Lumen Endotracheal Tube by Lateral Positioning: A Prospective Observational Study

Jong-Hae Kim, Eugene Kim, In-Young Kim, Eun-Joo Choi, Sung-Hye Byun, Jong-Hae Kim, Eugene Kim, In-Young Kim, Eun-Joo Choi, Sung-Hye Byun

Abstract

Proper bronchial cuff pressure (BCP) is important when using a double-lumen endotracheal tube (DLT), especially in thoracic surgery. As positional change during endotracheal tube placement could alter cuff pressure, we aim to evaluate the change in BCP of DLT from the supine to the lateral decubitus position during thoracic surgery. A total of 69 patients aged 18-70 years who underwent elective lung surgery were recruited. BCP was measured at a series of time points in the supine and lateral decubitus positions after confirming the DLT placement. The primary outcome was change in the initial established BCP (BCPi), which is the maximum pressure at which the BCP did not exceed 40 cmH2O without air leak in the supine position, after lateral decubitus positioning. As the primary outcome, the BCPi increased from 25.4 ± 9.0 cmH2O in the supine position to 29.1 ± 12.2 cmH2O in the lateral decubitus position (p < 0.001). Out of the 69 participants, 43 and 26 patients underwent surgery in the left-lateral decubitus position (LLD group) and the right-lateral decubitus position (RLD group) respectively. In the LLD group, the BCPi increased significantly (p < 0.001) after lateral positioning and the beginning of surgery and the difference value, ∆BCPi, from supine to lateral position was significantly higher in the LLD group than in the RLD group (p = 0.034). Positional change from supine to lateral decubitus could increase the BCPi of DLT and the increase was significantly greater in LLD that in RLD.

Keywords: cuff; double-lumen tube; lateral position; pressure; thoracic surgery.

Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
The changes of BCPi at supine position, after lateral positioning and after starting the VATS operation. The black circles show the mean BCPi values with standard deviation of the patients in the LLD group. The white circles show the mean BCPi values with standard deviation of the patients in the RLD group. * p < 0.001 compared to supine position, † p = 0.001 compared to lateral position, ‡ p < 0.05 compared to supine position, § p < 0.05 compared to lateral position. BCPi, initial established bronchial cuff pressure; VATS, video-assisted thoracoscopic surgery; LLD, left lateral decubitus; RLD, right lateral decubitus.
Figure 2
Figure 2
The changes of PIP at supine position and after later positioning. The grey boxes show the mean PIP with standard deviation of the patients in the LLD group. The white boxes show the mean PIP with standard deviation of the patients in the RLD group. * p = 0.001 compared to supine position. PIP, peak inspiratory pressure; LLD, left lateral decubitus; RLD, right lateral decubitus.

References

    1. Brodsky J.B. Lung separation and the difficult airway. Br. J. Anaesth. 2009;103:i66–i75. doi: 10.1093/bja/aep262.
    1. Hannallah M., Benumof J.L., Silverman P.M., Kelly L.C., Lea D. Evaluation of an approach to choosing a left double-lumen tube size based on chest computed tomographic scan measurement of left mainstem bronchial diameter. J. Cardiothorac. Vasc. Anesth. 1997;11:168–171. doi: 10.1016/S1053-0770(97)90208-1.
    1. Wu C.Y., Yeh Y.C., Wang M.C., Lai C.H., Fan S.Z. Changes in endotracheal tube cuff pressure during laparoscopic surgery in head-up or head-down position. BMC Anesthesiol. 2014;14:75. doi: 10.1186/1471-2253-14-75.
    1. Seegobin R.D., van Hasselt G.L. Endotracheal cuff pressure and tracheal mucosal blood flow: Endoscopic study of effects of four large volume cuffs. Br. Med. J. 1984;288:965–968. doi: 10.1136/bmj.288.6422.965.
    1. Sengupta P., Sessler D.I., Maglinger P., Wells S., Vogt A., Durrani J., Wadhwa A. Endotracheal tube cuff pressure in three hospitals, and the volume required to produce an appropriate cuff pressure. BMC Anesth. 2004;4:8. doi: 10.1186/1471-2253-4-8.
    1. Athiraman U., Gupta R., Singh G. Endotracheal cuff pressure changes with change in position in neurosurgical patients. Int. J. Crit. Illn. Inj. Sci. 2015;5:237–241. doi: 10.4103/2229-5151.170841.
    1. Joh S., Matsuura H., Kotani Y., Sugiyama K., Hirota Y., Kiyomitsu Y., Kubota Y. Change in tracheal blood flow during endotracheal intubation. Acta Anaesthesiol. Scand. 1987;31:300–304. doi: 10.1111/j.1399-6576.1987.tb02571.x.
    1. Seo J.H., Cho C.W., Hong D.M., Jeon Y., Bahk J.H. The effects of thermal softening of double-lumen endobronchial tubes on postoperative sore throat, hoarseness and vocal cord injuries: A prospective double-blind randomized trial. Br. J. Anaesth. 2016;116:282–288. doi: 10.1093/bja/aev414.
    1. Knoll H., Ziegeler S., Schreiber J.U., Buchinger H., Bialas P., Semyonov K., Graeter T., Mencke T. Airway injuries after one-lung ventilation: A comparison between double-lumen tube and endobronchial blocker: A randomized, prospective, controlled trial. Anesthesiology. 2006;105:471–477. doi: 10.1097/00000542-200609000-00009.
    1. Araki K., Nomura R., Urushibara R., Yoshikawa Y., Hatano Y. Bronchial cuff pressure change caused by left-sided double-lumen endobronchial tube displacement. Can. J. Anaesth. 2000;47:775–779. doi: 10.1007/BF03019480.
    1. Araki K., Nomura R., Urushibara R., Yoshikawa Y., Hatano Y. Displacement of the double-lumen endobronchial tube can be detected by bronchial cuff pressure change. Anesth. Analg. 1997;84:1349–1353. doi: 10.1213/00000539-199706000-00032.
    1. Slinger P.D., Chripko D. A clinical comparison of bronchial cuff pressures in three different designs of left double-lumen tubes. Anesth. Analg. 1993;77:305–308. doi: 10.1213/00000539-199308000-00015.
    1. Kim D., Jeon B., Son J.S., Lee J.R., Ko S., Lim H. The changes of endotracheal tube cuff pressure by the position changes from supine to prone and the flexion and extension of head. Korean J. Anesthesiol. 2015;68:27–31. doi: 10.4097/kjae.2015.68.1.27.
    1. Kim H.C., Lee Y.H., Kim E., Oh E.A., Jeon Y.T., Park H.P. Comparison of the endotracheal tube cuff pressure between a tapered- versus a cylindrical-shaped cuff after changing from the supine to the lateral flank position. Can. J. Anaesth. 2015;62:1063–1070. doi: 10.1007/s12630-015-0394-z.
    1. Lizy C., Swinnen W., Labeau S., Poelaert J., Vogelaers D., Vandewoude K., Dulhunty J., Blot S. Cuff pressure of endotracheal tubes after changes in body position in critically ill patients treated with mechanical ventilation. Am. J. Crit Care. 2014;23:e1–e8. doi: 10.4037/ajcc2014489.
    1. Choi E., Park Y., Jeon Y. Comparison of the cuff pressure of a TaperGuard endotracheal tube and a cylindrical endotracheal tube after lateral rotation of head during middle ear surgery: A single-blind, randomized clinical consort study. Medicine. 2017;96:e6257. doi: 10.1097/MD.0000000000006257.
    1. Kim E., Kim I.Y., Byun S.H. Effect of lateral positioning on the bronchial cuff pressure of a left-sided double-lumen endotracheal tube during thoracic surgery: Study protocol for a prospective observational study. BMJ Open. 2019;9:e026606. doi: 10.1136/bmjopen-2018-026606.
    1. Campos J.H. Update on tracheobronchial anatomy and flexible fiberoptic bronchoscopy in thoracic anesthesia. Curr. Opin. Anaesthesiol. 2009;22:4–10. doi: 10.1097/ACO.0b013e32831a43ab.
    1. Byun S.H., Kang S.H., Kim J.H., Ryu T., Kim B.J., Jung J.Y. Comparison of a tube-holder (Rescuefix) versus tape-tying for minimizing double-lumen tube displacement during lateral positioning in thoracic surgery: A prospective, randomized controlled study. Medicine. 2016;95:e4486. doi: 10.1097/MD.0000000000004486.
    1. Ubukata Y., Suga H., Morita Y., Ida M., Mera H. Curvature of the left main bronchus caused by postural change from supine to left lateral position. J. Anesth. 2018;32:649–651. doi: 10.1007/s00540-018-2521-9.
    1. Dailey M.E., O’Laughlin M.P., Smith R.J. Airway compression secondary to left atrial enlargement and increased pulmonary artery pressure. Int. J. Pediatr. Otorhinolaryngol. 1990;19:33–44. doi: 10.1016/0165-5876(90)90193-U.
    1. Taskin V., Bates M.C., Chillag S.A. Tracheal carinal angle and left atrial size. Arch. Intern. Med. 1991;151:307–308. doi: 10.1001/archinte.1991.00400020065014.
    1. Yamada Y., Tanabe K., Nagase K., Ishihara T., Iida H. A Comparison of the Required Bronchial Cuff Volume Obtained by 2 Cuff Inflation Methods, Capnogram Waveform-Guided Versus Pressure-Guided: A Prospective Randomized Controlled Study. Anesth. Analg. 2021;132:827–835. doi: 10.1213/ANE.0000000000005179.
    1. Cohen E. Anesthesia for video-assisted thoracoscopic surgery. In: Slinger P., editor. Principles and Practice of Anesthesia for Thoracic Surgery. Springer; New York, NY, USA: 2011. pp. 331–340.
    1. Karzai W., Schwarzkopf K. Hypoxemia during One-lung Ventilation: Prediction, Prevention, and Treatment. Anesthesiology. 2009;110:1402–1411. doi: 10.1097/ALN.0b013e31819fb15d.
    1. Mi W., Zhang C., Wang H., Cao J., Li C., Yang L., Guo F., Wang X., Yang T. Measurement and analysis of the tracheobronchial tree in Chinese population using computed tomography. PLoS ONE. 2015;10:e0123177. doi: 10.1371/journal.pone.0123177.
    1. Rosero E.B., Ozayar E., Eslava-Schmalbach J., Minhajuddin A., Joshi G.P. Effects of Increasing Airway Pressures on the Pressure of the Endotracheal Tube Cuff During Pelvic Laparoscopic Surgery. Anesth. Analg. 2018;127:120–125. doi: 10.1213/ANE.0000000000002657.
    1. Kim T.K., Min J.J., Seo J.H., Lee Y.H., Ju J.W., Bahk J.H., Hong D.M., Jeon Y. Increased tracheal cuff pressure during insertion of a transoesophageal echocardiography probe: A prospective, observational study. Eur. J. Anaesthesiol. 2015;32:549–554. doi: 10.1097/EJA.0000000000000204.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere