To Investigate The Accuracy of Tube Selection According to Ultrasonographic Airway Measurements in Patients Undergoing OLV

Objectives: Double-lumen endobronchial tubes (DLTs) are often used in one-lung ventilation (OLV). However, there is no optimal guide or parameter to estimate the accurate size of a DLT. The aim of this study was to investigate the role of ultrasonographic measurements—including tracheal width (TW), cricoid width (CW), lung offset, pulmonary pulse, and diaphragmatic motion—in selecting the correct DLT size.
Methods: Thirty-four patients undergoing thoracic surgery requiring OLV were included in the study. In the selection of DLT size, a scale based on sonographic tracheal width (TW) and the patient’s height was used. Sonographic lung measurements (SLM), including lung offset, pulmonary pulse, and diaphragmatic motion, were also used to confirm the location of the DLT, as compared to fiberoptic bronchoscopy (FOB).
Results: The mean DLT size was 39 Fr, while the mean BCV was 2.5 mm. BCV was found to be suitable (successful intubation) in 29 patients (85.3%) and non-suitable (failed intubation) in 5 patients (14.7%). The three SLMs—lung shift, pulmonary pulse, and diaphragmatic movement—were 100% compatible with intubation and OLV.
Conclusion: The sonographic TW- and height-based scale had an 85.3% success rate in determining the appropriate DLT size. Sonographic measurements of the lung were also found to be 100% compatible with intubation and OLV. Despite these promising results, sonographic measurements seem unlikely to replace FOB in DLT positioning. However, they may be helpful for selecting DLT size and confirming its placement, especially in the absence of FOB, in the presence of mucous plaque, or during emergency surgery.