The Fast and Easy Way for Double-Lumen Tube Intubation: Individual Angle-Modification

Abstract

To find the faster and easier way than the existing intubating technique for double-lumen tube, we modified the angle of double-lumen tube according to an individual's upper airway anatomy and compared the time needed and the number of attempts for successful intubation between individually angle-modified and non-modified double-lumen tubes. Adult patients undergoing elective thoracic surgery were randomly allocated in either non-angle-modified (Group N, n = 54) or angle-modified (Group M, n = 54) groups. During mask ventilation in the sniffing position, angle-modification was performed in Group M as follows: the distal tip of the tube was placed at the level of the cricoid cartilage and the shaft was bent at the intersection of the oral and pharyngeal axes estimated from the patient's surface anatomy. The time needed and the number of attempts for successful intubation and Cormack and Lehane (C-L) grade were recorded. Overall median intubation time (sec) was significantly shorter in Group M than in Group N [10.2 vs. 15.1, P<0.001]. In addition, Group M showed the shorter median intubation time (sec) in C-L grades I-III [8.2 vs. 11.1 in C-L grade I, (P = 0.003), 10.3 vs. 15.3 in II, (P = 0.001), and 11.8 vs. 27.9 in III, (P<0.001), respectively]. Moreover, all intubation was successfully performed at the first attempt in patients with C-L grades I-III in Group M (P = 0.027). Our study showed an individual angle-modification would be useful for the fast and easy intubation of double-lumen tube in patients with C-L grades I-III.

Trial registration: ClinicalTrials.gov NCT02190032.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Consort diagram.

Group N, non-modified double-lumen tube group; Group M, individually angle-modified double-lumen tube group

Fig 2. Tube angle-modification in the angle-modified double-lumen tube group.

OA, oral axis; PA, pharyngeal axis; (A) With the patient’s head in the sniffing position, the oral and pharyngeal axes were assessed on the lateral side of the face. (B) The distal tip of the tube was positioned at the upper margin of the cricoid cartilage. (C) The tube shaft was bent at the intersection of the imaginary oral and the pharyngeal axes in order to produce a fluent curve.

Fig 3. Comparison of the median intubation times between the groups.

Group N, non-modified double-lumen tube group; Group M, individually angle-modified double-lumen tube group). (A) Overall analysis of the patients. (B) Subgroup analysis according to the Cormack and Lehane (C-L) grade. (C) Subgroup analysis according to the Cormack and Lehane (C-L) grade with the BURP (backward, upward, and rightward pressure on the larynx) technique.