A double-lumen endotracheal tube (also called double-lumen endobronchial tube or DLT) is a type of

endotracheal tube A tracheal tube is a catheter that is inserted into the trachea for the primary purpose of establishing and maintaining a patent airway and to ensure the adequate exchange of oxygen and carbon dioxide. Many different types of tracheal tubes are a ...

which is used in

tracheal intubation Tracheal intubation, usually simply referred to as intubation, is the placement of a flexible plastic catheter, tube into the vertebrate trachea, trachea (windpipe) to maintain an open airway or to serve as a conduit through which to administer c ...

during thoracic surgery and other medical conditions to achieve selective, one-sided

ventilation Ventilation may refer to: * Ventilation (physiology), the movement of air between the environment and the lungs via inhalation and exhalation ** Mechanical ventilation, in medicine, using artificial methods to assist breathing *** Respirator, a ma ...

of either the right or the left lung.

Indications

There are several conditions that may make one-sided lung ventilation necessary. Absolute indications include separation of the right from the left lung to avoid spillage of blood or pus from an infected or bleeding side to the unaffected side. Relative indications include the collapse of one lung and the selective ventilation of the remaining lung in order to facilitate exposure of the anatomical structures to be operated on in thoracic surgeries, such as the repair of a thoracic

aortic aneurysm An aortic aneurysm is an enlargement (dilatation) of the aorta to greater than 1.5 times normal size. Typically, there are no symptoms except when the aneurysm dissects or ruptures, which causes sudden, severe pain in the abdomen and lower back ...

pneumonectomy A pneumonectomy (or pneumectomy) is a surgical procedure to remove a lung. It was first successfully performed in 1933 by Dr. Evarts Graham. This is not to be confused with a lobectomy or segmentectomy, which only removes one part of the lung. T ...

lobectomy Lobectomy means ''surgical excision of a lobe''. This may refer to a lobe of the lung (also simply called a lobectomy), a lobe of the thyroid ( hemithyroidectomy), a lobe of the brain (as in anterior temporal lobectomy), or a lobe of the liver ...

.Miller, Ronald.D, Anesthesia, Fifth edition
Section 4: Subspecialty Management, Chapter 48:Anesthesia for Thoracic Surgery
, published by Churchill Livingstone (2000)

Development and description

A DLT is made up of two small-lumen endotracheal tubes of unequal length fixed side by side. The shorter tube ends in the

trachea The trachea (: tracheae or tracheas), also known as the windpipe, is a cartilaginous tube that connects the larynx to the bronchi of the lungs, allowing the passage of air, and so is present in almost all animals' lungs. The trachea extends from ...

while the longer one is placed in either the left or right

bronchus A bronchus ( ; : bronchi, ) is a passage or airway in the lower respiratory tract that conducts air into the lungs. The first or primary bronchi to branch from the trachea at the carina are the right main bronchus and the left main bronchus. T ...

in order to selectively ventilate the left or right lung respectively. The first double-lumen tube used for bronchospirometry and later for one-lung

anaesthesia Anesthesia (American English) or anaesthesia (British English) is a state of controlled, temporary loss of sensation or awareness that is induced for medical or veterinary purposes. It may include some or all of analgesia (relief from or prev ...

in humans was introduced by Carlens in 1949. Modifications to the original Carlens tube have been introduced by White, Robertshaw and others. The most commonly used DLT today is the Robertshaw tube (introduced in 1962). These allow single-lung ventilation while the other lung is collapsed to make thoracic surgery easier or possible. This may be necessary so as to facilitate the surgeon's view and access to relevant structures within the

thoracic cavity The thoracic cavity (or chest cavity) is the chamber of the body of vertebrates that is protected by the thoracic wall (rib cage and associated skin, muscle, and fascia). The central compartment of the thoracic cavity is the mediastinum. Ther ...

. The deflated lung is re-inflated as surgery finishes to check for leakages or other injuries. These tubes are typically

coaxial In geometry, coaxial means that several three-dimensional linear or planar forms share a common axis. The two-dimensional analog is ''concentric''. Common examples: A coaxial cable has a wire conductor in the centre (D), a circumferential ou ...

, with two separate channels and two separate openings. They incorporate an endotracheal lumen which terminates in the trachea and an endobronchial lumen, the distal tip of which is positioned 1–2 cm into the right or left mainstem bronchus. Proper placement of DLTs requires considerable clinical experience, various techniques for their insertion having been developed. And there is a small simulator to help in the training of Carlens tube rotation maneuvers. Placement has been found to be easier with the aid of fiber optical equipment such as a

bronchoscope Bronchoscopy is an endoscopic technique of visualizing the inside of the airways for diagnostic and therapeutic purposes. An instrument (bronchoscope) is inserted into the airways, usually through the nose or mouth, or occasionally through a tr ...

. Currently, flexible fiberoptic bronchoscopy examination is recommended before, during placement, and at the conclusion of the use of DLTs.

Alternatives

Other methods of achieving a one sided lung ventilation are the Univent tube, which has a single tracheal lumen and blocker, and other endobronchial blockers.Campos, Javier H,
Which device should be considered the best for lung isolation: double-lumen endotracheal tube versus bronchial blockers
Current Opinion in Anesthesiology: February 2007 - Volume 20 - Issue 1 - p 27-31 The approach to ventilating each lung via a separate ventilator is called the DuoVent approach. This system operates by connecting both ventilators to a master control unit, allowing for synchrony between the two ventilators.

Indications

Development and description

Alternatives

See also

References

Further reading