A comparison of techniques for placement of double-lumen endobronchial tubes

Study Objective: To compare two methods of double-lumen endobronchial tube placement for thoracic surgery and to identify factors that provide a rational basis for placement method selection. Design: Prospective, randomized study. Setting: Teaching hospital. Patients: 58 ASA physical status II, III, and IV patients scheduled for surgical procedures requiring elective left-sided endobronchial intubation. Interventions: Patients were assigned randomly to either a group in which the initial placement method was the traditional approach of placing the endobronchial tube through the larynx and then advanced blindly into the left mainstem bronchus, or to a second group in which the left mainstem bronchus was intubated under direct vision using the fiberoptic bronchoscope. Measurements and Main Results: Of the 32 patients who underwent the traditional approach, primary success occurred in 27 patients and eventual success in 30. In 27 patients undergoing the directed approach, primary success occurred in 21 patients and eventual success in 25. Two patients in each group required the alternative method. The blind approach took 88 (± 91) seconds and the directed approach took 181 (± 193) seconds (p = 0.029). Timing data were analyzed using analysis of variance with respect to method and secretions and then t-tests as appropriate. Categorical data were analyzed using the Kruskal-Wallis and Fisher's exact tests as appropriate. All values are reported as means ± SD. Conclusion: Both the blind and directed approaches resulted in successful left mainstem placement of the endobronchial tube in the majority of patients but either method may fail when used alone. More time was required using the directed approach. Operator experience with both methods will increase the likelihood of success. The choice of the initial approach may be influenced by patient factors as well as available equipment and personnel.