• Emanuela Roldi, Paolo Inghileri, Ophélie Dransart-Raye, Silvia Mongodi, Pierre-Grégoire Guinot, Francesco Mojoli, and Belaïd Bouhemad.
• From the Department of Anesthesiology and Intensive Care, C.H.U. Dijon (ER, PI, P-GG, BB, OD-R), Dijon and Université Bourgogne Franche-Comté, LNC UMR866, Dijon Cedex, France (P-GG, BB, OD-R), Anaesthesia and Intensive Care, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Policlinico San Matteo, Pavia, Italy (SM, FM) and Unit of Anaesthesia and Intensive Care, Department of Clinical-Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy (ER, FM).
• Eur J Anaesthesiol. 2019 Mar 1; 36 (3): 215-220.

BackgroundLeft double-lumen tubes (LDLTs) are used in thoracic surgery to allow one-lung ventilation. Their size is usually chosen on the basis of clinical parameters (height, sex). Double-lumen endobronchial tubes are frequently undersized/oversized, risking tube displacement or tracheal trauma. A correlation between ultrasound tracheal diameter and left main bronchus dimension has been demonstrated.ObjectivesWe hypothesised that the insertion of undersized/oversized double-lumen tubes is frequent when the size is selected using standard criteria, and that the use of ultrasound to estimate tracheal diameter may help to reduce the frequency of insertion of oversized tubes.DesignTwo-step prospective observational study.SettingThe operating room of a French University hospital from January 2016 to February 2017.PatientsWe enrolled 102 and 50 consecutive patients undergoing elective thoracic surgery in Steps 1 and 2 (males 63.7 and 60.0%, age 63 (13) and 63 (11) years, height 170 (13) and 169 (9) cm, respectively).InterventionIn Step 1, the size of the LDLT inserted was selected on the basis of clinical parameters. Ultrasound data about tracheal diameter were collected to determine cut-off points associating height and tracheal diameter. Cut-off values for ultrasound tracheal diameter were applied retrospectively to test their capability to reduce the insertion rate of oversized tube. In Step 2, the LDLT size was chosen according to the determined combined cut-off values.Main Outcome MeasureLDLT size was considered adequate if the bronchial cuff volume required for isolation of the lung (i.e. no difference between inspiratory and expiratory lung volumes) was 0.5 to 2.5 ml of air; undersized and oversized tubes required more than 2.5 ml and less than 0.5 ml, respectively.ResultsIn Step 1, LDLT size was appropriate/undersized/oversized in 40 (39.2%)/23 (22.6%)/39 (38.6%) of patients. Cut-off values derived from ultrasound measurements would have reduced the use of oversized tubes by 20.6% (P < 0.001). In Step 2, the frequency of use of adequately sized tubes increased (86.0 vs. 39.2%, P < 0.001), and the frequency of insertion of oversized and undersized tubes decreased (6.0 vs. 38.2% and 8.0 vs. 22.6%, both P < 0.001).ConclusionCombining ultrasound measurement of tracheal diameter and clinical parameters improves the choice of LDLT size.

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