Comparison of the accuracy of three methods measured the length of the right main stem bronchus by chest computed tomography as a guide to the use of right sided double-lumen tube

Abstract

Background: The variation of right main stem bronchus leads to the orifice of the right upper lobe bronchus may be obstructed or increase the incidence of malposition intraoperatively when the right sided double-lumen tube is used. Therefore, the aim of this study was to compare the accuracy of three methods measured the length of the right main stem bronchus via chest computed tomography as a guide to the use of right sided double-lumen tube.

Methods: In this study, 168 adult patients undergoing left sided thoracic surgery were included. All these patients were allocated to carina-proximal (C-P) group, carina-distal (C-D) group and carina-carina (C-C) group. The position of endobronchial cuff observed via Fiberoptic bronchoscopy after successful initial placement and after turning the patients to the lateral decubitus position, as well as the incidence of malposition of right sided double-lumen tube intraoperative were recorded to assess the accuracy of three methods in predicting the position of right sided double-lumen tube.

Results: The distance between the carina to the proximal margin of the right upper lobe orifice, carina to the distal margin of the right upper lobe orifice and carina to the first right interlobar carina of the right upper lobe orifice were 17.2 ± 2.3 mm, 25.4 ± 3.7 mm and 28.5 ± 3.1 mm (P < 0.05). In the C-D group, the number of endobronchial cuffs seen to be herniating out of the carina, the number of bronchoscopies during initial placement and on the lateral position, the number of total malposition intraoperative and the number of reposition manoeuvres intraoperative were significantly less than the C-P group or the C-C group (P < 0.05).

Conclusions: The length of the right main stem bronchus measured by the carina to distal margin of right upper lobe orifice method was more accurate than the other two methods in guiding the use of right sided double-lumen tube.

Trials registration: Clinical Trials. gov. no. NCT04127903. Registered at https://register.

Clinicaltrials: gov on 16/10/2019.

Keywords: Carina-carina distance; Carina-distal distance; Carina-proximal distance; Computed tomography; Right sided double-lumen tube.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1

A Carina-proximal margin method; B Carina-distal margin method; C Carina-carina method; D The distance between the uppermost edge of the cuff and the proximal margin of the ventilation slot; E The distance between the uppermost edge of the cuff and the distal margin of the ventilation slot; F The distance between the uppermost edge of the cuff and the distal margin of the ventilation slot on the contralateral side of carina

Fig. 2

Flowchart

Fig. 3

The distal margin of right upper lobe ventilation slot aligned with the distal margin of the right upper lobe orifice

Fig. 4

The scores of bronchial cuff position: A 1 = invisible; B 2 = visible, not herniated; C 3 = slight herniation, ventilation maintained; D 4 = herniation, inadequate ventilation