Placement Of A Double Lumen Tube Over An Airway Exchange Catheter In An Unanticipated Difficult Airway Without Fibreoptic Bronchoscope—A Case Report

10.5580/16b1 ◽  
2009 ◽  
Vol 19 (2) ◽  
Keyword(s):  
Case Report ◽  
Difficult Airway ◽  
Fibreoptic Bronchoscope ◽  
Double Lumen Tube ◽  
Double Lumen ◽  
Lumen Tube ◽  
Airway Exchange Catheter ◽  
Exchange Catheter ◽  
Airway Exchange

Extubation of the Difficult Airway

2019 ◽  
Author(s):  
Alison Dalton
Keyword(s):  
At Risk ◽  
Difficult Airway ◽  
Fiberoptic Bronchoscopy ◽  
Airway Exchange Catheter ◽  
Airway Edema ◽  
Exchange Catheter ◽  
Patients At Risk ◽  
Complicating Factors ◽  
Retrograde Intubation ◽  
Airway Exchange

It is well known that induction and intubation are periods associated with patient risk. Especially in the case of patients with known or suspected difficult airways, extubation may be associated with similar risk. Therefore, attempts at extubation must be well planned, and preparations for urgent or emergent intubation must be in order prior to removal of an endotracheal tube. Preparations should be made on a case-by-case basis with consideration given to that specific patient’s indications for difficult airway management. Patients at risk for airway obstruction from edema require different techniques and preparations compared with those patients at risk for intracranial hypertension. Advanced preparations should include consideration of the best location for extubation (ie, OR, PACU, ICU), required tools (ie, airway exchange catheter, videolaryngoscope, fiberoptic bronchoscope supraglottic device), and personnel. A thorough plan for emergent reintubation should be considered taking into account the patient’s baseline airway anatomy, previous difficulty of intubation, subsequent airway edema, hemodynamics, and other complicating factors (ie, patient now in a Halo device, jaw wiring).  This review contains 5 figures, 6 tables, and 45 references. keywords: airway edema, airway exchange catheter, cricothyrotomy, difficult airway, difficult intubation, extubation, fiberoptic bronchoscopy, retrograde intubation

scholarly journals Efficacy of height-based formula to predict insertion depth of left-sided double lumen tube: A prospective observational study

2020 ◽  
Vol 48 (5) ◽  
pp. 354-357
Author(s):  
Abdelazeem A Eldawlatly ◽  
Mohamed R El Tahan ◽  
Naveed U Kanchi ◽  
Ahmad Al Qatari ◽  
Abdulaziz E Ahmad
Keyword(s):  
Body Height ◽  
Fibreoptic Bronchoscope ◽  
Double Lumen Tube ◽  
Double Lumen ◽  
Insertion Depth ◽  
Optimal Position ◽  
Lumen Tube ◽  
Optimum Position ◽  
Tube Position ◽  
Ethical Approval

The insertion depth of the left-sided double-lumen tube needs careful positioning and bronchoscopic confirmation. Several formulae based on body height have been used for estimating the optimal insertion depth of a left-sided double-lumen tube. We conducted this prospective study to test the hypothesis that our earlier developed height-based formula (0.25 × body height0.916) could predict the accurate insertion depth of a left-sided double-lumen tube. After obtaining ethical approval, 66 patients who underwent thoracic surgery were included. A left-sided double-lumen tube was advanced blindly to the predicted depth of insertion calculated using our formula. The optimal position of the left-sided double-lumen tube was confirmed using a fibreoptic bronchoscope. The primary outcome was the percentage of tubes placed in the optimal position without the need for further adjustments. The secondary outcomes included the need for bronchoscopic adjustments and the final correct insertion depth of the left-sided double-lumen tube. The formula resulted in an optimum position of the left-sided double-lumen tube without further adjustments in 45 patients (70%) (95% confidence interval 58%–80%). The left-sided double-lumen tube was withdrawn or advanced in 18.2% and 12.1%, respectively, to achieve the optimal insertion depth. We found that our formula provided satisfactory positioning in about 70% of patients and that in the remaining patients, the adjustments required to achieve satisfactory positioning under fibreoptic bronchoscope guidance were minimal. Nevertheless, as it is not possible to predict which patients will have a satisfactory tube position, bronchoscopic confirmation for the final positioning is still required.

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