The Fast and Easy Way for Double-Lumen Tube Intubation: Individual Angle-Modification

To find the faster and easier way than the existing intubating technique for double-lumen tube, we modified the angle of double-lumen tube according to an individual’s upper airway anatomy and compared the time needed and the number of attempts for successful intubation between individually angle-modified and non-modified double-lumen tubes. Adult patients undergoing elective thoracic surgery were randomly allocated in either non-angle-modified (Group N, n = 54) or angle-modified (Group M, n = 54) groups. During mask ventilation in the sniffing position, angle-modification was performed in Group M as follows: the distal tip of the tube was placed at the level of the cricoid cartilage and the shaft was bent at the intersection of the oral and pharyngeal axes estimated from the patient’s surface anatomy. The time needed and the number of attempts for successful intubation and Cormack and Lehane (C-L) grade were recorded. Overall median intubation time (sec) was significantly shorter in Group M than in Group N [10.2 vs. 15.1, Pvs. 11.1 in C-L grade I, (P = 0.003), 10.3 vs. 15.3 in II, (P = 0.001), and 11.8 vs. 27.9 in III, (PP = 0.027). Our study showed an individual angle-modification would be useful for the fast and easy intubation of double-lumen tube in patients with C-L grades I-III.Trial Registration: ClinicalTrials.gov NCT02190032

为探寻优于现有双腔气管导管（double-lumen tube）插管技术的快捷简便方案，我们依据患者个体上气道解剖结构调整双腔导管的角度，并对比了个体化角度调整组与未调整组双腔导管的成功插管所需时长及尝试次数。择期行胸腔手术的成年患者被随机分配至非角度调整组（N组，n=54）与角度调整组（M组，n=54）。在嗅物位行面罩通气期间，M组的角度调整操作如下：将导管远端尖端置于环状软骨（cricoid cartilage）水平，根据患者体表解剖结构估算出口腔与咽腔轴线的交点，将导管杆部于此位置弯折。本研究记录了成功插管所需时长、插管尝试次数以及Cormack与Lehane（C-L）分级。M组的总体插管中位时长（秒）显著短于N组[10.2 vs. 15.1，P<0.001]；按C-L分级分层后，I级患者的插管时长为10.3 vs. 11.1（P=0.003），II级为10.3 vs.15.3（P=0.001），III级为11.8 vs.27.9（P=0.027）。本研究表明，对于C-L分级I至III级的患者，个体化角度调整有助于实现双腔气管导管的快捷简便插管。试验注册：ClinicalTrials.gov NCT02190032