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Double-Lumen Tubes for Tracheostomized Patients

Published:April 08, 2015DOI:https://doi.org/10.1053/j.jvca.2015.02.011
      To the Editor:
      We thank Dr. Steven N. Neustein for his precise and concise article in the section, Pro and Con, entitled “Pro: Bronchial Blockers Should Be Used Routinely for Providing One-Lung Ventilation.”
      • Neustein S.M.
      Pro: Bronchial Blockers Should Be Used Routinely for Providing One-Lung Ventilation.
      The author mentions that there is no commercially available double-lumen tube (DLT) that can be used in the presence of a tracheostomy.
      We cannot agree with this statement as we use, in our institution, a specific DLT for tracheostomized patients (Rüsch Tracheopart®, Teleflex Medical Europe Ltd., Athlone, Co, Westmeathare, Ireland). Its use already has been described in the literature
      • Masamune T.
      • Matsukawa T.
      • Ookawa I.
      • et al.
      Double-lumen tracheostomy tube (Tracheopart) used in two patients for one-lung ventilation under general anesthesia.
      . Those DLTs offer the same design as conventional DLTs, but are shorter and curved between the intratracheal and extratracheal parts. The set of double-lumen tracheostomy tubes also included an adjustable flange and an adjustable neckband to stabilize the tube after its insertion.
      It is introduced via a standard tracheostomy, which should preserve the first or the first and second tracheal cartilages in order to protect the cricoid. When positioning this DLT, you always should keep the tracheal opening pointed to the dorsal wall of the trachea. After confirmation of a good positioning, preferentially by bronchoscopic control, the tracheostomy DLT is stabilized by the adjustable flange, which is connected to the adjustable neckband.
      Three sizes are marketed. They differ in the intratracheal length of the double-lumen segment (Fig 1A). They exist in 75 mm (up to 165 cm body length), in 85 mm (165-175 cm body length), and 95 mm (above 180 cm body length). You also can estimate the individual length of the trachea by taking a chest x-ray in inspiration at a scale of 1:1. The distance between the center of the first thoracic vertebra and the carina usually corresponds to the distance between the tracheostomy and the carina. On the Rüsch Tracheopart®, the distance corresponds to the length between the apex of the curvature and the cranial margin of the cuff (Fig 1B). This length is 105 mm for a DLT of 75 mm, 115 mm for a DLT of 85 mm and 125 mm for a DLT of 95 mm.
      Figure thumbnail gr1
      Fig 1Double-lumen tube for tracheostomized patient (Rüsch Tracheopart®).
      Those devices are available for left-sided (ref 11 64 00) and right-sided (ref 11 64 01) bronchial intubation. The external and both internal diameters are unique (13.9 mm [39Fr] and 4.76 mm, respectively).

      Rüsch Tracheopart®, Double-lumen tracheostomy tube set: Instructions for use. Teleflex Medical Europe Ltd., Athlone, Co Westmeathare, Ireland.93 12 30 Rev. E 04 12.

      In conclusion, DLTs specially designed for patients with tracheostomy are commercially available. Their use is easy, and their fixation is stable even when the body position of the patient is changed from supine to lateral. Special attention must be provided to the length of their intratracheal portion. The diameter is unique, but left-sided and right-sided tubes are available.

      References

        • Neustein S.M.
        Pro: Bronchial Blockers Should Be Used Routinely for Providing One-Lung Ventilation.
        J Cardiothorac Vasc Anesth. 2014; 29: 234-236
      1. TELEFLEX AIRWAYS (Brochure). Available at : http://www.teleflex.com/commonInternet/emea/documentLibrary/listDocuments/emea?result-display-mode=compact&product-area=airwayManagementRespiratoryCare. Accessed on March 30,2015.

        • Masamune T.
        • Matsukawa T.
        • Ookawa I.
        • et al.
        Double-lumen tracheostomy tube (Tracheopart) used in two patients for one-lung ventilation under general anesthesia.
        Masui. 2004; 53: 1418-1420
      2. Rüsch Tracheopart®, Double-lumen tracheostomy tube set: Instructions for use. Teleflex Medical Europe Ltd., Athlone, Co Westmeathare, Ireland.93 12 30 Rev. E 04 12.

      Linked Article

      • Pro: Bronchial Blockers Should Be Used Routinely for Providing One-Lung Ventilation
        Journal of Cardiothoracic and Vascular AnesthesiaVol. 29Issue 1
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          ONE-LUNG VENTILATION (OLV) traditionally has been provided with the use of a double-lumen tube (DLT). The use of bronchial blockers (BBs) to provide lung isolation has grown in recent years. Despite the development of BBs specifically designed for lung separation, the DLT has remained the preferred technique for providing lung isolation. A recent survey in the United Kingdom revealed a 98% preference rate for the DLT,1 and 64% of respondents reported rarely using a BB to provide lung isolation. A number of arguments have been advanced to support the notion that a DLT is superior to a BB and should be used routinely for providing OLV.
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      • Double-Lumen Tube for Use With a Tracheostomy
        Journal of Cardiothoracic and Vascular AnesthesiaVol. 29Issue 3
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          I thank Dr. Dincq et al for their interest in my article and their kind words in which they refer to it as precise and concise.
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