Aliases:
Double lumen ETT
DLT
DL ETT

Topic aliases are alternate phrasings for a particular topic.


A double lumen tube allows isolation of, and differential access to, each lung.

There are absolute & relative indications for their use. Surgical exposure is a relative indication.

Initial size estimate techniques may be utilised, but ultimately a properly sized DLT should pass through the glottis without trauma and advance easily into the trachea and bronchus while adequately sealing for independent left and right lung ventilation.

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Absolute indication:
Control of distribution of ventilation (bronchopleural fistula, surgical opening of large airway, tracheobronchial tree disruption, giant unilateral lung cyst)

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Absolute indication:
Lung isolation to prevent contralateral spillage/contamination from infection/ haemorrhage, or unilateral broncho-pulmonary lavage (eg for pulmonary alveolar proteinosis)

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Relative indication:
Surgical exposure is a relative indication but a high priority in thoracic AAA, pneumonectomy, upper lobectomy, and low priority in oesophageal resections, thoracic verterbral surgery, & thoracoscopy

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Railroading over a long Bougie /Cook airway exchange catheter can lead to inadvertantly deep or premature endobronchial intubation. Any sign of high airway pressures should cause suspicion that the DLT is misplaced.

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Avoid tearing the cuffs on the teeth during insertion. Bend the introducer to suit the airway. Using alcohol swab packaging to cover sharp teeth may help.

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If lung isolation is required for patients with a tracheostomy, a standard DLT will likely be too stiff to insert. Use a bronchial blocker instead if this is the case. refl.in/9o

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The challenge with a right sided tube is ensuring the bronchus to the RUL (which comes off close to corina) is not obstructed by the endobronchial cuff. Image from refl.in/bo

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A left tube is commonly used unless: anatomical distortion of the left main stem (ie. due to a tumour or aortic arch compression); or surgery involving the left mainstem bronchus

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Difficult laryngoscopy

In the presence of a difficult laryngoscopy, an awake fibreoptic technique with a single lumen ETT is possible, followed by a DLT railroaded over a cook exchange-catheter. refl.in/9o

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Simplified sizing.
Female <160cm = 35 Fr, >160cm = 37 Fr.
Male <170cm = 39 Fr, >170cm = 41 Fr.
If female < 152cm, examine bronch diameter on CT & consider a 32 Fr.
Males <160 cm consider a 37 Fr.

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Size of DLT( in French ) = 4 X internal diameter of normal ETT(in mm) + 2.

Yao & Artusio's Anesthesiology, 6th edition, Ch 2, Pg 37

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Mar 03, 2013
Doesn't sound right. Check reference. Yep, thats what it says...
When setting up the DLT remove the introducer, insert the connecting adapters, and then reinsert the introducer (back into the endobronchial lumen).
If the patient desaturates after intubation you want to be able to quickly connect the circuit and not fumble around connecting the bare end of the ETT to the connector.

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Initial depth of insertion is 29cm plus or minus 1cm for every 10cm above or below 170cm in height. Adequacy of depth should be assessed clinically +- bronchoscopically. #ref

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Initial depth of insertion of left side double lumen ETT in (cm) = 12.5 + (0.1 x height (cm)) refl.in/bl

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Good resource on FRCA website www.frca.co.uk/article.as...

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Insert to expected depth, then inflate tracheal cuff to the minimal volume that seals the air leak.
Confirm bilateral ventilation.
Tracheal lumen of the DLT is then clamped & it's port opened.
Ventilate via the bronchial lumen, inflating bronchial cuff until air leak from the open tracheal lumen port stops.
Confirm unilateral ventilation.
Tracheal lumen clamp is released and the port closed.
Confirm bilateral ventilation.

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Awake fiberoptic intubation with a DLT is possible, but the large external diameter & length (shortens the manipulatable length of fiberoptic scope that protrudes) makes it difficult refl.in/9o

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