• J. Cardiothorac. Vasc. Anesth. · Apr 2018

    Randomized Controlled Trial

    Computed Tomographic Window Setting for Bronchial Measurement to Guide Double-Lumen Tube Size.

    • Jeong-Hwa Seo, Jinyoung Bae, Hyesun Paik, Chang-Hoon Koo, and Bahk Jae-Hyon JH Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Kor.
    • Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
    • J. Cardiothorac. Vasc. Anesth. 2018 Apr 1; 32 (2): 863-868.

    ObjectivesThe bronchial diameter measured on computed tomography (CT) can be used to guide double-lumen tube (DLT) sizes objectively. The bronchus is known to be measured most accurately in the so-called bronchial CT window. The authors investigated whether using the bronchial window results in the selection of more appropriately sized DLTs than using the other windows.DesignCT image analysis and prospective randomized study.SettingTertiary hospital.ParticipantsAdults receiving left-sided DLTs.InterventionsThe authors simulated selection of DLT sizes based on the left bronchial diameters measured in the lung (width 1,500 Hounsfield unit [HU] and level -700 HU), bronchial (1,000 HU and -450 HU), and mediastinal (400 HU and 25 HU) CT windows. Furthermore, patients were randomly assigned to undergo imaging with either the bronchial or mediastinal window to guide DLT sizes. Using the underwater seal technique, the authors assessed whether the DLT was appropriately sized, undersized, or oversized for the patient.Main Measurements And ResultsOn 130 CT images, the bronchial diameter (9.9 ± 1.2 mm v 10.5 ± 1.3 mm v 11.7 ± 1.3 mm) and the selected DLT size were different in the lung, bronchial, and mediastinal windows, respectively (p < 0.001). In 13 patients (17%), the bronchial diameter measured in the lung window suggested too small DLTs (28 Fr) for adults. In the prospective study, oversized tubes were chosen less frequently in the bronchial window than in the mediastinal window (6/110 v 23/111; risk ratio 0.38; 95% CI 0.19-0.79; p = 0.003). No tubes were undersized after measurements in these two windows.ConclusionsThe bronchial measurement in the bronchial window guided more appropriately sized DLTs compared with the lung or mediastinal windows.Copyright © 2017 Elsevier Inc. All rights reserved.

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