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BJA Advance Access originally published online on June 17, 2008
British Journal of Anaesthesia 2008 101(3):411-418; doi:10.1093/bja/aen166
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2008. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Electrical impedance tomography to confirm correct placement of double-lumen tube: a feasibility study

D. Steinmann1,*,{dagger}, C. A. Stahl1,{dagger}, J. Minner1, S. Schumann1, T. Loop1, A. Kirschbaum2, H. J. Priebe1 and J. Guttmann1

1 Department of Anaesthesia and Critical Care Medicine
2 Department of Thoracic Surgery, University Medical Center Freiburg, Hugstetter Strasse 55, D-79106 Freiburg, Germany

* Corresponding author. E-mail: daniel.steinmann{at}uniklinik-freiburg.de

Background: Double-lumen tubes (DLTs) are frequently used to establish one-lung ventilation (OLV). Their correct placement is crucial. We hypothesized that electrical impedance tomography (EIT) reliably displays distribution of ventilation between left and right lung and may thus be used to verify correct DLT placement online.

Methods: Regional ventilation was studied by EIT in 40 patients requiring insertion of left-sided DLTs for OLV during thoracic surgery. EIT was recorded during two-lung ventilation before induction of anaesthesia and after DLT placement, and during OLV in the supine and subsequently in the lateral position. EIT measurements were made before and after verification of correct DLT placement by fibreoptic bronchoscopy (FOB).

Results: EIT accurately displayed distribution of ventilation between left and right lung online. All cases (n=5) of initially misplaced DLTs in the contralateral right main bronchus were detected by EIT. However, EIT did not allow prediction of FOB-detected endobronchial cuff misplacement requiring DLT repositioning. Furthermore, after DLT repositioning, distribution of ventilation, as assessed by EIT, did not change significantly (all P>0.5).

Conclusions: This study demonstrates that EIT enables accurate display of left and right lung ventilation and, thus, non-invasive online recognition of misplacement of left-sided DLTs in the contralateral main bronchus. However, as distribution of ventilation did not correlate with endobronchial cuff placement, EIT cannot replace FOB in the routine control of DLT position.

Keywords: anaesthetic techniques, bronchoscopy; equipment, tubes double-lumen; measurement techniques, transthoracic electrical impedance; ventilation, one-lung

{dagger} The first two authors contributed equally to this work.


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Use of electrical impedance tomography for checking the correct placement of double-lumen tube
Inéz Frerichs, et al.
British Journal of Anaesthesia, 31 Aug 2008 [Full text]

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