A logical approach to the selection and insertion of double-lumen tubes

There has been a progressive evolution in double-lumen tubes to separate the right and left lungs. The appreciation of the anatomical advantage of the longer left main bronchus has directed anesthetists to prefer a left tube if possible for lung separation. Understanding the dimensions of the tube as well as the variations in the left main bronchus has improved the process of selection and insertion of the double-lumen tubes for lung isolation.

Early work focused on the anatomy of the longer left main bronchus. More recent work looked at the tube. This showed that tubes of the same nominal French size were substantially different in the size of the bronchial tube diameter and length. The proposed International Standards Organization standard will more accurately identify tube dimensions. These factors must be considered when selecting a tube for lung separation.

Measurement of patient's airway dimensions combined with knowledge of the dimensions of the double-lumen (tracheobronchial) tube plays an important role in lung separation.