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LETTER TO THE EDITOR

What Is the Best Choice for Size of Double Lumen Tube?

Department of Anesthesiology; The Mount Sinai Medical Center; steve.neustein{at}msnyuhealth.org

To the Editor:

Amar et al.1 successfully demonstrated no difference in either the incidence of hypoxemia, or malposition of double lumen tube (DLT), by routinely using a 35 Fr left DLT, compared with sizing the DLT according to patient height.

Using a larger size DLT will lessen the chance of a distal migration, resulting in a malposition and possible hypoxemia. However, if FOB is used, both of these problems can easily be checked for, lessening the need for using a larger tube. It does make sense that using a smaller than traditionally sized tube, with concomitant use of FOB, is a safe practice, and offers certain advantages. The study by Amar et al.1 may become important, in that the conventional method of selecting the largest size DLT is questioned.2 Before recommending widespread changes in practice, there should be a prospective randomized follow-up study, in which the individual practitioners use both techniques. I agree with the authors that further work is needed.

Footnotes

Dr. Amar does not wish to reply.

REFERENCES

1. Amar D, Desiderio D, Heerdt PM, Kolker AC, Zhang H, Thaler HT. Practice patterns in choice of left double-lumen tube size for thoracic surgery. Anesth Analg 2008;106:379–83[Abstract/Free Full Text]
2. Brodsky J, Macario A, Mark J. Tracheal diameter predicts double-lumen tube size: a method for selecting left double-lumen tubes. Anesth Analg 1996;82:861–864[Web of Science][Medline]

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