Double lumen tubes malposition and hypoxemia during one-lung ventilation

L. Băilă¹, R. Bencze², M. Chiorean¹
1) Catedra Terapie Intensivă - Urgenţe, Universitatea de Medicină şi Farmacie Târgu-Mureş
2) Secţia A.T.I., Spitalul Municipal Odorheiu Secuiesc

Abstract

Aim: The evaluation of the incidence of double lumen tubes (DLT) malposition, the necessity for bronchoscopy in DLT positioning and the evaluation of hypoxemia during one-lung ventilation (OLV) for thoracic surgery.

Material and methods. 235 patients ASA I-III scheduled for thoracothomy/thoracoscopy in one-lung anesthesia were divided in two groups: A group (138 patients) in which initial DLT malposition - M0 (immediately after DLT introduction), first malposition - M1 (after turning the patient in lateral decubitus position) and second malposition - M2 (occurred during OLV) were checked only by clinical methods (alternative clamping) without bronchoscopy. In group B (97 patients) the three types of malpositions were revealed by the aid of bronchoscopy, using specific criteria. Both techniques of evaluation of DLT positioning were compared in terms of sensivity and specificity and the consequences of their use in the incidence of M2 and hypoxemia (SpO2 < 90%) were estimated.

Results. Bronchoscopy was found to be more sensible in detecting M0 compared with the clinical method (20.51% vs 16.66%, p < 0.0001); there were no significant differences between the methods in M1 occurrence (19.56% vs 24.74%, p < 0.05). With the aid of bronchoscopy, in group B the incidence of M2 (26.08% vs 14.43%, p < 0.05) and hypoxemia (22.49 vs 11.34, p < 0.05) was significantly reduced. There is a strong correlation between M2 as an event and hypoxemia (p = 0.0008 < 0.05), DLT malposition during OLV being the most frequent etiological factor. A statistically significant percent of patients who presented M1 presented M2also, suggesting an instability of DLT in certain anatomical conditions.
Conclusions. The use of bronchoscopy in one-lung anaesthesia is a modality of decreasing the number of hypoxemic episodes during OLV and avoiding a life-threatening event - malposition of DLT during surgery (M2). There is a correlation between the two types of malposition (M1 and M2) in terms of repetitiveness in the same patient.
Key words: hypoxemia, malposition, one-lung ventilation, double lumen tube

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Malpoziţia canulelor cu dublu lumen şi hipoxemia în cursul ventilaţiei unipulmonare

Jurnalul Român de Anestezie Terapie intensivă 2005 Vol.12 Nr.1, 5-13