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A double-lumen tube (DLT) is an endotracheal tube designed to isolate the lungs anatomically and physiologically. Double-lumen tubes (DLTs) are the most commonly used tubes to provide independent ventilation for each lung. One-lung ventilation (OLV) or lung isolation is the mechanical and functional separation of the 2 lungs to allow selective ventilation of only one lung. The other lung that is not being ventilated passively deflates or is displaced by the surgeon to facilitate surgical exposure for non-cardiac operations in the chest such as thoracic, esophageal, aortic and spine procedures. This activity reviews the use of the DLT, its indications, contraindications, and complications in thoracic surgery. Objectives: Describe how a double-lumen tube is inserted during surgery. Review the indications for a double-lumen tube. Summarize the complications of a double-lumen tube. Outline interprofessional team strategies to ensure proper placement of the double-lumen tube during thoracic surgery and improving patient outcomes. Access free multiple choice questions on this topic.

A double-lumen tube (DLT) is an endotracheal tube designed to isolate the lungs anatomically and physiologically.[1] Double-lumen tubes (DLTs) are the most commonly used tubes to provide independent ventilation for each lung. One-lung ventilation (OLV) or lung isolation is the mechanical and functional separation of the 2 lungs to allow selective ventilation of only one lung. The other lung that is not being ventilated passively deflates or is displaced by the surgeon to facilitate surgical exposure for non-cardiac operations in the chest such as thoracic, esophageal, aortic and spine procedures. It can also be used during minimally invasive cardiac surgery and in disease processes affecting 1 lung to prevent soiling from the contralateral lung. DLTs also allows bronchial toilet without interrupting ventilation.

The most lethal complication arising from the use of a DLT is airway rupture from traumatic placement.[17][18] Injury to tongue, lips, and teeth may also occur from laryngoscopy. A majority of airway injuries were associated with undersized DLTs, particularly in females who received a 35-Fr or 37-Fr DLT.[19] Undersized DLTs tend to migrate too far distally into the main stem bronchus, or that the endobronchial cuff requires a larger amount of air when smaller tubes are used predisposing to mucosal ischemia. Other complications include hypoxemia due to tube malposition, displacement, tube occlusion from secretions or blood. Inadvertent entrapment of the DLT in suture lines during procedures have also been reported. Malposition of the DLT can lead to life-threatening consequences. Ventilation can be severely impaired, leading to hypoxia, gas trapping, tension pneumothorax, cross-contamination of lung contents, and interference with surgical procedures.[20] Factors predisposing to airway injury include: Inserting a DLT too forcefully Placing undersized DLTs Overdistention of the endobronchial cuff Reposition of the DLT with the cuffs inflated Preexisting pathology of the airway including tumors

Double-lumen tubes are used for multiple complex surgical procedures and lung isolation in some non-surgical patients. Since malposition and displacement of these tubes can lead to life-threatening consequences, an interprofessional education is an essential component to avoid morbidity and mortality. Everyone involved in the care of patients requiring DLT placement including anesthesiologists, intensivists, resident physicians, CRNAs, AAs, nurses, and respiratory therapists in the intensive care unit must know the indications for placement, identify correct placement, confirm the position, and be able to troubleshoot complications from the placement of DLT. Daily chest x-ray and auscultation to confirm placement and bronchoscopy should be immediately available if malposition is suspected. Respiratory status should be monitored continuously, and caution should be used during the positioning and transport of patients. The need for continued placement should be addressed daily as these tubes have the potential for airway injury and should be changed to SLTs if mechanical ventilation is still needed, but lung isolation is no longer indicated.