Practices of Sizing of Left-Sided Double Lumen Tubes at a Tertiary-Referral Cancer Centre in India: A Retrospective Cohort Study.
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BACKGROUND AND AIMS: Formulae for the determination of size of the left-sided double-lumen tubes (DLTs) have not been validated in the Indian population. This audit was carried out to examine the sizes of the left-sided DLTs (L-DLTs), commonly used in the Indian patients, to identify the adequacy of lung isolation and problems during lung isolation. METHODS: This was a retrospective cohort study at a high-volume tertiary-care cancer centre in India. We included patients over 15-years-old, who required lung isolation using a L-DLT, operated between January 2017 and March 2022. We collected data from anesthesia records and electronic medical records on patient height, size of L-DLT used, difficulty in L-DLT insertion and intra-operative problems. Data were reported as means (or medians) for numerical data, and proportions for categorical data. RESULTS: Of 564 patients, sizes of L-DLTs used versus size predicted by height were smaller in 388 (69%), larger in 9 (2%), and same as predicted in 167 (29%). Patients receiving larger L-DLT had higher failure rate for L-DLT insertion than patients who received smaller or predicted size L-DLTs [3/9 (33%) versus 11/555 (2%); P = 0.001)]. Sixty-nine (12.4%) patients (50 with smaller size and 19 with predicted-size L-DLTs) had minor intraoperative problems including malposition, high airway pressures, inadequate cuff seal, intraoperative desaturation, and hypercarbia. CONCLUSION: The use of smaller-sized L-DLTs did not affect success of lung isolation, quality of lung collapse or ease of one-lung ventilation. The use of DLTs larger than predicted for height was associated with higher insertion failure rates.