What are the contraindications to the use of double-lumen endotracheal tubes (DLTs)?
Answer:
Placement of a DLT should be carefully considered in the following situations:
Patients whose upper airway anatomy may preclude safe insertion such as recessed jaw, prominent teeth, bull neck, anterior larynx, mandibular surgery, and neck radiation
Patients with lesions along the pathway of the tube that could be traumatized, such as airway stricture or endoluminal tumors
Small patients for whom a 35 or 32 French tube is too large to fit comfortably through the larynx and a 28 French tube is considered too small
Critically ill patients already intubated who cannot tolerate cessation of mechanical ventilation and positive end-expiratory pressure (PEEP) for a short time.
Under these circumstances, single-lung ventilation can be achieved via an endobronchial blocker. Endobronchial placement of a single-lumen tube for lung isolation is an alternative but suboptimal option. The tip of the ETT can cause direct distal airway trauma, whereas significant airway compression with potential mucosal ischemia may occur if the cuff bulges at carina. When placed on the right side, the right upper lobe will be occluded by the cuff of the tube, preventing the ability to ventilate.
Reference(s):
- Campos JA. Update on lung separation techniques. Rev Mex Anestesiol. 2011;34:S270-S277.
- Gropper MA, Cohen NH, Eriksson LI, et al, eds. Miller’s Anesthesia. 9th ed. Philadelphia, PA: Elsevier; 2020:1663-1700.
- Licker M, Le Guen M, Diaper J, et al. Isolation of the lung: double-lumen tubes and endobronchial blockers. Trends Anaesth Crit Care. 2014;4:47-54.