Influence of Tracheal-bronchial Anatomy Changes on Multi-detector Computed Tomography Scan of the Chest Upon Placement of Left-Sided Double Lumen Endotracheal Tube
Influence of Tracheal-bronchial Anatomy Changes on Multi-detector Computed Tomography Scan of the Chest Upon Placement of Left-Sided Double Lumen Endotracheal Tube
One-lung ventilation (OLV) is used for thoracic surgical procedures to facilitate surgical
 exposure. Lung isolation is performed using a double-lumen endotracheal tube (DLT) and
 optimal position is achieved with the use of fiberoptic bronchoscopy. The most common
 technique used to place a left-sided DLT is the blind method technique, which consists of
 direct laryngoscopy and rotation of the DLT into the trachea with the aim to intubate the
 entrance of the left main bronchus. The DLT will be rotated counterclockwise blindly after
 the tip of the DLT passes the vocal cords under direct laryngoscopy. However, in some
 occasions, the tip of the DLT migrates into the right bronchus because the alignment between
 the trachea and right bronchus is more vertical. The identification of the misplacement can
 be challenging, which could lead to the failure of lung isolation. In order to avoid the
 unsuccessful lung isolation, Investigators are interested in identifying the factors that
 potentially influence the incorrect tube DLT placement diverting into the opposite bronchus.
Recently, multi-detector 3-dimensional computed tomography (MDCT) scan of the chest is
 becoming a routine study for patients requiring thoracic surgical procedures. On the day of
 thoracic surgery, the participant will be intubated with a left-sided DLT and investigators
 will confirm the correct insertion of the left-sided DLT at first pass under direct
 laryngoscopy. This information will be recorded and saved. After the study is completed,
 investigators will review the MDCT of the chest to review any abnormal findings and correlate
 it with the success of the insertion of the left-sided DLT into the left bronchus.
 Investigators will conduct a pilot study to determine the most influential anatomical change
 that leads to the DLT misplacement at the first pass based upon the changes of the
 tracheal-bronchial anatomy on MDCT.
Inclusion Criteria:

 -  At least 18 years of age

 -  Adult patient undergoing scheduled thoracic surgery which requires left side double
 lumen tube placement

 Exclusion Criteria:

 -  More than 90 years of age

 -  Patients with emergency surgery

 -  Prisoners

 -  Patients who cannot provide their own consent

 -  Patient refusal

 -  Non-English speaking patients