Main bronchial diameters in patients with very severe COPD

This retrospective study was performed in order to determine if patients with very severe chronic obstructive pulmonary disease (COPD) have larger main bronchi than patients with less severe disease.

Charts of patients having had a spirometric evaluation of their COPD and a digitized thin-slice computed tomography (CT) scan between January 2004 and September 2007 were reviewed. Adequate CT scans of male patients [i.e., those allowing a multiplane reconstruction (MPR) of the upper tracheobronchial tree using a double orthogonal oblique method] were divided into two groups: group 1 [forced expiratory volume in 1 s (FEV(1)) ranging from 30% to 80%] and group 2 (FEV(1) < 30%).

Intraobserver and interobserver coefficients of repeatability were 1.79 and 2.51 mm, respectively. Median values and interquartile ranges of minimum right main bronchial diameter were 11.0 (9.6-12.7) mm versus 12.7 (10.8-13.9) mm in groups 1 (27 patients) and 2 (10 patients), respectively (P = 0.048); values for the minimum left main bronchial diameter were 10.7 (8.9-11.9) mm versus 11.8 (11.2-12.4) mm in groups 1 and 2, respectively (P = 0.040). The difference between the groups in median values of the minimum right and left main bronchial diameters was 1.2 mm. Other values were similar in both groups.

The difference in minimum main bronchial diameters between our two groups corresponded to a difference of two or three sizes of a double-lumen tube. This difference must be taken into account for tube selection for such patients. Further studies are needed to prove that CT scan MPR can improve patients' intraoperative care.