The use of lung‐ultrasound to confirm correct placement of left sided double lumen tubes

[摘要] Study objective: To assess the accuracy of the ultrasonographic lung sliding sign in detectingcorrect positioning of the endotracheal double‐lumen tube after intubation, compared toflexible bronchoscopy, in adult patients who present for thoracic surgery requiring one lungventilation.Design: Prospective clinical study.Setting: Cardiothoracic theatre, Universitas Hospital, Bloemfontein.Patients: 30 adult patients, 18 years of age or older, who present for elective thoracic surgery,and require endotracheal left sided double‐lumen tube intubation after induction ofanaesthesia for lung isolation.Intervention and measurement: The presence of the lung sliding sign was determined with anultrasound on all 30 patients before induction of anaesthesia and after intubation, as well aspost lung isolation. All patients were intubated with a left sided double‐lumen tube. TheAnaesthetic consultant or registrar then performed a flexible bronchoscopy on all patients toverify the position of the double‐lumen tube.Results: A total of 17 patients were enrolled in the study. 1 Patient was excluded who was lessthan 18 years of age. In 1 case no bronchoscope was available to confirm correct position ofthe double‐lumen tube. In 11 cases the presence of the lung sliding sign pre‐intubation on theaffected side was absent, and thus could not be used in comparing ultrasound findings withbronchoscopy. The overall sensitivity of the ultrasonographic lung‐sliding to confirm correctplacement was 94.1% (confidence interval 73.0 to 99.0%). The positive predictive value was100%.Conclusion: The presence of the lung‐sliding sign before induction of anaesthesia was absent ina high number of patients (37.9%). Our study suggests that, for patients with the presence ofthe lung‐sliding sign pre‐induction of anaesthesia, the ultrasonographic lung‐sliding sign canaccurately detect correct positioning of the double‐lumen tube as compared to the goldstandard which is a flexible bronchoscope. We therefore recommend that patients should firstbe assessed for the presence of lung‐sliding pre‐intubation before deciding on ultrasound as themeans to confirm correct double‐lumen tube placement. Ultrasound will therefore not be ableto replace bronchoscopy in thoracic surgery.

[发布机构] University of the Free State