Independent lung ventilation (ILV) was first used in thoracic surgery and the intubation devices were developed for this purpose. Gale and Waters first reported ILV in 1931, by passing a single-lumen endobronchial tube into the main bronchus of the dependent nonoperative lung for ventilation and exclusion of purulent secretion (if present) from the operative lung. In 1936, Magill1 reported endobronchial placement of a suction catheter with a balloon to occlude the operative bronchus and tracheal placement of an ETT to ventilate the nonoperative lung. In 1947, Moody2 encased the endobronchial balloon with metal studs to reduce the risk of balloon dislodgment.
The first double-lumen tube (DLT), enabling independent ventilation of both lungs, was reported by Carlens3 in 1949. Thus, tube was similar to current left DLTs, but had a rubber “hook” to engage the carina for accurate placement. Although a major advance, this tube caused trauma and was unsuitable for left pneumonectomy. The first right DLT, which did not occlude the right upper lobe bronchus, was not reported until 1960 by White.4 In 1962, Robertshaw5 reported right and left DLTs, which served as the prototype of today’s DLTs. Current DLTs have replaced red rubber with polyvinyl chloride (PVC) to reduce mucosal injury and improve malleability and airflow (Fig. 25-1).
(A) Right and (B) left polyvinyl chloride (PVC) (Mallinckrodt) double-lumen tubes (DLT) shown against a schematic of the trachea and major airways.
For many years, DLTs and ILV were used entirely for thoracic surgery.2,5,6 In 1976, Glass and Trew7,8 and their coworkers reported ILV for nonsurgical purposes: respiratory insufficiency from unilateral lung disease. Since then, application of ILV has broadened to a wide range of conditions (Table 25-1) employing a variety of techniques. Institutions specializing in conditions commonly requiring ILV (such as single lung transplantation or alveolar proteinosis), ILV may be used in approximately 0.5% of all mechanically ventilated patients.9,10 Although most intensive care units use ILV in fewer than one in 1000 patients requiring mechanical ventilation, it can be a lifesaving measure in specific conditions, making maintenance of suitable equipment and knowledge of its use required.
Table 25-1: Polyvinyl Chloride Double-Lumen Tubes: Choice of Size ||Download (.pdf)
Table 25-1: Polyvinyl Chloride Double-Lumen Tubes: Choice of Size
|Size (French)||OD (mm)||Tracheal ID (mm)||Bronchial ID (mm)||Use||Manufacturera|
|28||9.3||3.1||3.2||Children weighing <40 kg||Mallinckrodt|
|35||11.7||4.5||4.3||Children weighing >40 kg||Mallinckrodt|
|39||13.0||4.9||4.9||Medium adults, usual female size||Mallinckrodt|
|41||13.7||5.4||5.4||Large adult, usual male size||Mallinckrodt|