Mechanical Complications of the Double-Lumen Tube

First Author(s)

• 

  Erica Chemtob

  Medical Student
  n/a

  Disclosure information not submitted.

  Slides and Audio

Co-Author(s)

• DK

  David Kauffman

  Medical Student
  The George Washington University School of Medicine and Health Sciences, United States

  Disclosure information not submitted.
• CN

  Connie Nguyen

  Medical Student
  The George Washington University School of Medicine and Health Sciences, United States

  Disclosure information not submitted.
• AH

  Allison Hu

  Medical Student
  The George Washington University School of Medicine and Health Sciences, United States

  Disclosure information not submitted.
• RP

  Raymond Pla, MD

  Assistant Professor of Anesthesiology and Critical Care Medicine
  The George Washington University, United States

  Disclosure information not submitted.
• EH

  Eric Heinz, MD

  Assistant Professor of Anesthesiology and Critical Care Medicine
  George Washington University, United States

  Disclosure information not submitted.

Title: Mechanical Complications of the Double Lumen Tube

INTRODUCTION/HYPOTHESIS:
The Double Lumen Tube (DLT) is commonly used to facilitate one-lung ventilation in thoracic surgery, in which several mechanical complications have been noted by previous studies. The goal of our study is to identify the frequency of mechanical complications with the DLT at each anatomical location and classify the injuries using a severity score. From this study, we aim to inform patients and anesthesiologists on the risks associated with the DLT.

Methods:  
We independently and systematically searched the literature using PubMed using the following search term: complications; double lumen tube; one-lung ventilation; injury. This resulted in 251 studies. The following filters were then applied in Covidence: English language; human subjects; adult subjects (age ≥ 18 years). Forty-one studies met our specified inclusion and exclusion criteria, ten of which were randomized controlled trials. We organized the injuries by anatomical location and created an injury severity classification system to determine the frequency of minor to severe injuries graded I to IV; I as minor and IV as severe.

Results:  
We included 10 randomized control trials that met our inclusion criteria with a total of 2,554 participants. 1591 were males and 963 were females. The average age of participants was 56, average height was 168 cm, average weight was 67 kg, and average BMI was 23.7. Of the participants, 772 met criteria for American Society of Anesthesiologists (ASA) physical status classification of I, 1169 for ASA II, 390 for ASA III, and 5 for ASA IV. Of the 2,554 participants across the ten studies, we found that 64% experienced an oropharynx injury, 42% experienced a laryngeal or vocal cord injury, 31% experienced a tracheal injury, and 47% experienced a bronchial injury.

Conclusions:  
Our results show that the DLT can cause injury to the oropharynx, larynx and vocal cords, trachea, and the bronchi, with oropharynx injuries occurring the most frequently. We found that grade I injuries occurred more frequently than grade IV injuries at each anatomic location. However, severe injuries from the DLT can lead to morbidity and mortality, so a larger-scale observational study is needed to analyze predictors and risk factors associated with severe injury.