Positioning of double-lumen tubes based on the minimum peak inspiratory pressure difference between the right and left lungs in short patients: A prospective observational study

BACKGROUNDPeak inspiratory pressures (PIPs) during one-lung ventilation (OLV) have served as a clinical marker that could indirectly verify the proper positioning of double-lumen tubes (DLTs). Patients of short stature are highly susceptible to initial DLT malpositioning. OBJECTIVESWe investigated the usefulness of positioning left-sided DLTs using minimum PIP differences between the right and left lungs by comparing with the previously used method of auscultation without fibreoptic bronchoscopy (FOB). We also evaluated the difference in PIPs between the two lungs during OLV after the DLT was ideally positioned with FOB examination. DESIGNProspective, observational study. SETTINGA university hospital. PATIENTSOne hundred and two female patients of short stature (≤160 cm). INTERVENTIONSVerification of DLT position was conducted by three sequential stepsauscultation; minimising the difference in PIP during each OLV; and verifying the resulting position by FOB. MAIN OUTCOME MEASUREMENTSFibreoptic bronchoscopic view results of DLT position followed by the position adjustment using the minimum PIP difference method. RESULTSRepositioning the DLT using the minimum PIP difference led to clinically successful positioning of the DLT in 88% of patients and a more ideal placement of the tube than auscultation alone (69.6 vs. 11.8%, P