How do you place a double-lumen endotracheal tube?
Double-lumen tubes (DLTs) are the most preferred endotracheal tubes to provide independent ventilation for each lung. Intubation through this tube allows for selective ventilation of only one lung.
The DLT comprises two parallel lumens or passages called the tracheal and bronchial lumen. While placing it past the vocal cords into the trachea (windpipe), the shorter tracheal lumen will terminate in the trachea. The second, longer lumen will extend into either the left or right main bronchus (left or right lung).
There are two types of DLTs. There is a right-sided DLT for the right lung and left-sided DLT for the left lung.
The placement of a DLT is generally performed by an anesthetist in the following manner
- The anesthetist will administer general anesthesia to make you numb and sleep throughout the procedure. If you are unfit for anesthesia, you will be given sedatives to make you sleep.
- An instrument known as a laryngoscope will be inserted into the mouth to visualize your larynx (voice box) and vocal cords.
- The laryngoscope will be used as a guide to correctly insert the DLT past the vocal cords into your windpipe on either the right or left side. The windpipe is the part of your airway that is connected to your lungs.
- Your doctor may still need to check if the tube has been placed correctly. To confirm this, they will listen to your breathing with a stethoscope.
- The DLT will then be connected to the ventilator.
When is a double-lumen endotracheal tube needed?
A double-lumen tube (DLT) is indicated for surgeries or procedures requiring the isolation of one lung from the other lung during surgeries. It is needed
- To prevent damage or contamination of the healthy lung
- To prevent oozing of pus from a lung abscess
- To control the distribution of ventilation
- In severe unilateral lung diseases, such as when there is a major cyst or bulla
Deflation of one lung provides better surgical exposure for surgeries involving the esophagus (food pipe) and thoracic aorta and removal of a part of one lung (lobectomy or pneumonectomy).
What makes you unfit for intubation with a double-lumen endotracheal tube?
A double-lumen tube (DLT) has a larger size and more complex design than a single-lumen tube (SLT). Hence, intubation with a DLT can be a challenge. The doctor will avoid placing a DLT if you have
- A difficult airway
- A tracheal constriction (narrowing)
- Limited mouth opening
What happens after the insertion of the double-lumen endotracheal tube?
The doctor will check the double-lumen tube (DLT) daily to confirm that it is still in place. They may order daily chest X-rays to confirm its placement.
Your respiratory sounds and breathing rate will also be checked.
They may be replaced daily with a new tube and with a single-lumen tube (SLT), if needed.
What are the risks of using a double-lumen endotracheal tube?
Just like endotracheal intubation with a single-lumen tube (SLT), placement of a double-lumen tube (DLT) also carries the risk of a few complications such as
- Airway rupture
- Injury to the tongue, lips and teeth (from laryngoscopy)
- Hypoxemia (low blood oxygen level) due to tube malposition or displacement
- Tube obstruction from secretions or blood
- Tension pneumothorax (entrapment of air between the lungs and chest wall)
- Cross-contamination of the lung contents
- Interference with surgical procedures
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