New landmarks improve the positioning of the left Broncho-Cath™ double-lumen tube-comparison with the classic technique

Abstract

Purpose: To compare a new technique (NT) for positioning the left modified Broncho-Cath™ double-lumen tube (LM-DLT) by fibre-optic bronchoscopy (FOB) to the classic technique (CT). Methods: Sixty-one adult patients undergoing elective thoracic surgery with LM-DLT were randomly assigned to the NT or to the CT group. For the NT, the endoscopist confirms the left mainstem endobronchial intubation. The proximal edge of the blue bronchial cuff should not be visualized at the carina. Then, through the left bronchial lumen, by transparency across the wall of the tube, the position of the tube is adjusted so that the carina lies midway between the black radiopaque line and the top of the bronchial cuff. After this, the orifice of the left upper lobe (LUL) bronchus should be clearly seen. For the CT, the endoscopist uses the technique described by Benumof and Slinger. After lateral positioning of the patient, the LM-DLT was repositioned if the top of the endobronchial cuff was above the carina or when the LUL bronchus was obstructed. Results: The incidence of proximal repositioning was significantly less in the NT compared to the CT (16% vs 43%, P=0.007). Conclusion: Using this new technique, the LM-DLT is inserted deeper in the left mainstem bronchus. This new landmark augments the range of movement that can be tolerated without requiring repositioning of the LM-DLT. This NT to position and to assess LM-DLT, by transparency across the wall of the tube with FOB, is better adapted to the LM-DLT and its recent modifications.