The risk of a fragment or fragments shearing from a bougie on its removal from a DLT is well recognised 4, and these may remain in the tube or the patient's airway. The term ‘bougie’ may be used interchangeably with ‘intubating catheter’ or ‘intubating introducer’. However, the cheapest and most readily available adjunct is often a bougie, which is pre-loaded with a DLT and removed once the DLT has passed the glottis. Options to facilitate intubation with a DLT include videolaryngoscopes, rigid optical stylets, fibreoptic bronchoscopy and single-lumen tube intubation followed by use of an exchange catheter 3. Double curvature, increased diameter, the presence of the tracheal cuff and reduced bevel at the tip of the tube can make intubation with a DLT more difficult than with a single-lumen tracheal tube 2. Tracheal intubation with a double-lumen endobronchial tube (DLT) is often necessary for lung isolation and one-lung ventilation 1. Certain bougie–double-lumen tube combinations produced a particularly high degree of shearing, so these should be avoided. We found that brand of bougie, brand of double-lumen tube and size of double-lumen tube (but not its laterality) all influenced the degree of shearing. We inspected the inside of the tube for evidence of shearing after first, tenth and thirtieth removals. We simulated one intubation and 29 further insertions/removals of bougie with every bougie–double-lumen tube combination. We investigated three brands of double-lumen tube (each in three sizes and both lateralities) and four brands of bougie.
Double lumen tube trial#
We conducted a benchtop trial to investigate factors that influence the risk of shearing. It has even been suggested that bougies and double-lumen tubes should not be used together. These fragments have the potential to cause harm. Case reports have described fragment shearing from bougies when they are removed from the tube after intubation. A bougie can be used to facilitate intubation. Tracheal intubation with a double-lumen tube can be more challenging than with a single-lumen tube.
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