Objective: To observe the incidence of double-lumen endobronchial tubes (DLT) malposition caused by body position change or surgical manipulation and its impact on the efficacy of lung separation and ventilation.
Methods: Totally 688 patients undergoing thoracic surgery were enrolled in this study. The patients were intubated with Mallinckrodt DLT following intravenous anesthesia induction. The DLT position was corrected with fiberoptic bronchoscope (FOB), and successful lung separation and satisfactory ventilation were ensured during one-lung ventilation in the supine position. Bronchoscopy was performed immediately and the DLT position was corrected 15 minutes after dependent lung ventilation in the lateral position or in case of ineffective lung separation or SpO(2) declination to below 90%.
Results: DLT malposition occurred after lateralization in 112 (16.3%) patients, of whom 12.8% developed hypoxemia and 3.3% encountered air leak. The incidence of left-sided DLT malposition after lateralization was higher than that of right-sided DLT malposition (19.7% vs 12.2%, P<0.01). DLT malposition occurring in 112 patients after lateralization reoccurred in 16 (14.3%) patients during surgery, and the malposition incidence was significantly higher than that of malposition occurring only during surgery (1.2%, P<0.01).
Conclusion: Malposition of Mallinckrodt double-lumen tubes for lung separation during thoracic anesthesia occurs in 16.3% patients when shifting to lateral position, may reoccur in 14.3% of the patients despite previous FOB positioning.