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Table of Contents
Year : 2022  |  Volume : 25  |  Issue : 2  |  Page : 249-250
Comparison of different size left-sided double-lumen

Department of Anesthesiology, University of Mississippi Medical Center, Jackson, MS, USA

Click here for correspondence address and email

Date of Submission29-Dec-2021
Date of Acceptance30-Dec-2021
Date of Web Publication11-Apr-2022

How to cite this article:
Nguyen RD, Hierlmeier BJ, Kurnutala LN, Tucci MA. Comparison of different size left-sided double-lumen. Ann Card Anaesth 2022;25:249-50

How to cite this URL:
Nguyen RD, Hierlmeier BJ, Kurnutala LN, Tucci MA. Comparison of different size left-sided double-lumen. Ann Card Anaesth [serial online] 2022 [cited 2022 May 27];25:249-50. Available from:

To the Editor,

We appreciate the review and the comments regarding our article, “Comparison of different size left-sided double-lumen tubes for thoracic surgery.” Although we agree, one size cannot fit all, a 35F DLT can be safely used for most adult patients. Amar et al. also showed that the use of a 35F DLT in adults was associated with a similar and not worse incidence of the most common clinical outcomes in comparison to conventional sizing recommendations.[1],[2],[3],[4]

It has been recommended by some investigators to keep the bronchial cuff inflation pressures less than 25 cm H2O to avoid compromise of mucosal blood flow.[5] It has been demonstrated that cuff pressure does not necessarily correlate to pressure exerted on the bronchial wall.[5] We did not specifically record the pressure or the amount of air inflated in the bronchial cuff between the two groups; however, it was never more than 5 mL of air. Inflation of the bronchial cuff was only done under direct visualization with the fiberoptic scope and only enough air to create a visible seal around the left main bronchus. In our study, we had no issues maintaining the end tidal carbon dioxide (ETCO2) below 45 mmHg and no events of sustained high peak airway pressures or issues with ventilation.

A recent study published by Kar et al.[6] showed that a smaller DLT than recommended for lung isolation did not lead to any clinically appreciable problems in lung isolation, surgeon complaint, or complications associated with spillage. Time to lung collapse was not part of our study; however, we agree that a larger DLT may lead to quicker lung collapse when isolating. Although this may be statistically significant, it is unlikely to be clinically significant. Bussieres et al. showed that surgeons could not reliably determine which device was being used based on the time and quality of lung collapse when comparing double-lumen tubes and bronchial blockers.[7]

In conclusion, although there were limitations to our smaller study, we do agree that a 35F DLT cannot be used for all patients, but can safely be used in most adult patients.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

Seymour AH, Prakash N. A cadaver study to measure the adult glottis and subglottis: Defining a problem associated with the use of double-lumen tubes. J Cardiothorac Vasc Anesth 2002;16:196-8.  Back to cited text no. 1
Campos JH. Current techniques for perioperative lung isolation in adults. Anesthesiology 2002;97:1295-301.  Back to cited text no. 2
Slinger P. Lung isolation in thoracic anesthesia, state of the art. Can J Anaesth 2001;48:R1-10.  Back to cited text no. 3
Brodsky JB, Lemmens HJM. Left double-lumen tubes: Clinical experience with 1,170 patients. J Cardiothorac Vasc Anesth 2003;17:289-98.  Back to cited text no. 4
Hannallah MS, Gharagozloo F, Gomes MN, Chase GA. A comparison of the reliability of two techniques of left doublelumen tube bronchial cuff inflation in producing water-tight seal of the left mainstem bronchus. Anesth Analg 1998;87:1027-31.  Back to cited text no. 5
Kar P, Pathy A, Sundar AS, Gopinath R, Moningi S. Practice patterns of left-sided double-lumen tube: Does it match recommendation from literature - A single-center observational pilot study. Ann Card Anaesth 2019;22:51-5.  Back to cited text no. 6
[PUBMED]  [Full text]  
Bussières JS, Somma J, Del Castillo JL, Lemieux J, Conti M, Ugalde PA, et al. Bronchial blocker versus left double-lumen endotracheal tube in video-assisted thoracoscopic surgery: a randomized-controlled trial examining time and quality of lung deflation. Can J Anaesth. 2016;63:818-27. English. doi: 10.1007/s12630-016-0657-3. Epub 2016 May 2. PMID: 27138896.  Back to cited text no. 7

Correspondence Address:
Bryan J Hierlmeier
University of Mississippi Medical Center, 2500, N State St, Jackson, MS 39216
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/aca.aca_203_21

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