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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Control of distribution of ventilation (bronchopleural fistula, surgical opening of large airway, tracheobronchial tree disruption, giant unilateral lung cyst)
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Lung isolation to prevent contralateral spillage/contamination from infection/ haemorrhage, or unilateral broncho-pulmonary lavage (eg for pulmonary alveolar proteinosis)
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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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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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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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Yao & Artusio's Anesthesiology, 6th edition, Ch 2, Pg 37
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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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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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