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Double-lumen endobronchial tube

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A Carlens double-lumen endotracheal tube, commonly used for thoracic surgical operations such as VATS lobectomy.

The Double-lumen endotracheal tube (also called Double-lumen endobronchial tube or DLT) is a type of endotracheal tube which is used in tracheal intubation during thoracic surgery and other medical conditions, to achieve the selective one sided ventilation of either the right or the left lung.

Indications

There are several conditions that may make a one sided lung ventilation necessary. Absolute indications include separation of the right from the left lung to avoid spillage of blood or pus from an infected or bleeding side to the unaffected side. Relative indications include the collapsing of one lung and the selective ventilation of the remaining lung in order to facilitate exposure of the anatomical structures to be operated on in thoracic surgeries such as the repair of a thoracic aortic aneurysm, pneumonectomy or lobectomy.[1]

Development and description

A DLT is basically made up of two small lumen endotracheal tubes of unequal length fixed side by side. The shorter tube ends in the trachea, while the longer one is placed in either the left or right main bronchus in order to selectively ventilate the left or right lung respectively. The first double-lumen tube used for bronchospirometry and later for one-lung anaesthesia in humans was introduced by Carlens in 1949.[2][3] Modifications to the original Carlens tube have been introduced by White,[4] Robertshaw[5] and others. The most commonly used DLTs today are the Carlens and the Robertshaw tubes.[6]


These allow single-lung ventilation while the other lung is collapsed to make Thoracic surgery easier or possible. This may be necessary so as to facilitate the surgeon's view and access to relevant structures within the thoracic cavity. The deflated lung is re-inflated as surgery finishes to check for leakages or other injuries .

These tubes are typically coaxial, with two separate channels and two separate openings. They incorporate an endotracheal lumen which terminates in the trachea and an endobronchial lumen, the distal tip of which is positioned 1–2 cm into the right or left mainstem bronchus.

Proper placement of DLTs requires considerable clinical experience, various techniques for their insertion having been developed. [7] Placement has been found to be easier with the aid of a glottis simulator[8][9] or other fiber optical equipment such as a bronchoscope.[10]

Alternatives

Other methods of achieving a one sided lung ventilation are the Univent tube, which has a single tracheal lumen and blocker, and the endobronchial blockers.

References

  1. ^ Miller, Ronald.D, Anesthesia, Fifth edition , Section 4: Subspecialty Management, Chapter 48:Anesthesia for Thoracic Surgery, published by Churchill Livingstone (2000)
  2. ^ Carlens E (October 1949). "A new flexible double-lumen catheter for bronchospirometry". J Thorac Surg. 18 (5): 742–746. PMID 18149050.
  3. ^ Brodsky J.B, Lemmens H.J.M, "The history of anesthesia for thoracic surgery" Minerva anestesiologica, October 2007 p.519
  4. ^ White G.M.J, "A New Double lumen tube", Oxford JournalsMedicine BJA Volume 32, Issue 5Pp. 232-234 (1960)
  5. ^ Robertshaw F.L, "LOW RESISTANCE DOUBLE-LUMEN ENDOBRONCHIAL TUBES" Oxford JournalsMedicine BJA Volume 34, Issue 8Pp. 576-579 (1962)
  6. ^ Miller, Ronald.D, Anesthesia, Fifth edition , Section 4: Subspecialty Management, Chapter 48:Anesthesia for Thoracic Surgery, published by Churchill Livingstone (2000)
  7. ^ El-Etr AA. Improved technic for insertion of the Carlens catheter. Anesth Analg. 1969 Sep-Oct;48(5):738-40. http://www.anesthesia-analgesia.org/content/48/5/738.full.pdf
  8. ^ de Menezes Lyra R. Glottis simulator. Anesth Analg. 1999 Jun;88(6):1422-3.[1]
  9. ^ Smith, N Ty. Simulation in anesthesia: the merits of large simulators versus small simulators. Current Opinion in Anaesthesiology. 13(6):659-665, December 2000.
  10. ^ Miller, Ronald.D, Anesthesia, Fifth edition , Section 4: Subspecialty Management, Chapter 48:Anesthesia for Thoracic Surgery, published by Churchill Livingstone (2000)

Further reading

See also

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