Modified right-sided Broncho-Cath double lumen tube improves endobronchial positioning: a randomized study

A left-sided double lumen tube is recommended for one-lung ventilation for most thoracic surgeries, but for certain indications, a right-sided double lumen tube (R-DLT) may be mandatory. Frequent malposition of R-DLTs has been reported. We propose an innovative modification of Mallinckrodt's Broncho-Cath R-DLT consisting of an enlarged area of the lateral orifice, and studied the impact of this modification on the adequacy of R-DLT positioning.

Eighty adult patients scheduled for elective thoracic surgery were randomized into two groups: standard Broncho-Cath R-DLT, or modified Broncho-Cath R-DLT. After induction of anesthesia, the R-DLT was positioned using a fibreoptic bronchoscope. The position of the R-DLT was assessed on three occasions: with the patient supine (T1), then immediately following the patient's transfer to the lateral position (T2), and after repositioning of the tube, when needed, with the patient in lateral position (T3). A score ranging from 1 to 4 was accorded to the relative position of the right upper lobe (RUL) orifice in relation to the origin of the RUL bronchus.

The modified Broncho-Cath R-DLT was more frequently in an adequate position at T2: 77% vs 37% of patients (P = 0.0121), and easier to reposition at T3: 97% vs 74% of patients (P = 0.0109) in comparison to the standard Broncho-Cath R-DLT group.

These data suggest the superiority of the modified Broncho-Cath R-DLT compared to a standard Broncho-Cath R-DLT for optimal R-DLT positioning to facilitate one-lung ventilation during thoracic surgery.