• Users Online: 1074
  • Print this page
  • Email this page


 
 Table of Contents    
COMMENTS ON PUBLISHED ARTICLE
Year : 2016  |  Volume : 60  |  Issue : 3  |  Page : 226-227  

”A prospective comparative study to evaluate the utility of lung ultrasonography to improve the accuracy of traditional clinical methods to confirm position of left sided double lumen tube in elective thoracic surgeries”


Department of Anesthesia, Resuscitation and Pain, University Hospital Nuestra Señora de Candelaria, Tenerife, Spain

Date of Web Publication2-Mar-2016

Correspondence Address:
Nieves Gloria Alvarez Diaz
Department of Anesthesia, Resuscitation and Pain, University Hospital Nuestra Señora de Candelaria, Tenerife
Spain
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5049.177880

Rights and Permissions

How to cite this article:
Diaz NG. ”A prospective comparative study to evaluate the utility of lung ultrasonography to improve the accuracy of traditional clinical methods to confirm position of left sided double lumen tube in elective thoracic surgeries”. Indian J Anaesth 2016;60:226-7

How to cite this URL:
Diaz NG. ”A prospective comparative study to evaluate the utility of lung ultrasonography to improve the accuracy of traditional clinical methods to confirm position of left sided double lumen tube in elective thoracic surgeries”. Indian J Anaesth [serial online] 2016 [cited 2020 Oct 31];60:226-7. Available from: https://www.ijaweb.org/text.asp?2016/60/3/226/177880

Sir,

I read the article written by Parab et al. on the utility of lung ultrasonography to improve the accuracy of traditional clinical methods to confirm position of left sided double lumen tube in elective thoracic surgeries, with great interest.[1] I congratulate them for their magnificent work.

I would like to make a few comments. First, in their article, Parab et al. assert “lung ultrasonography (LU) does not detect selective lobar atelectasis. Hence, patients with right-sided double lumen tube (DLT) or with bronchial blocker were not included in this study.” Acosta et al. have tested the accuracy of transthoracic LU for diagnosing anaesthesia-induced atelectasis in children undergoing magnetic resonance imaging studies while breathing spontaneously, under sevoflurane anaesthesia. They reported that small anaesthesia-induced atelectasis was represented by juxtapleural consolidations associated with static air bronchograms, absence of A-lines and presence of B-lines. In large atelectatic areas, the absence of lung sliding (LS) and presence of lung pulse sign (LP) could be seen.[2]

In critically ill patients, dynamic air bronchogram and LP are two sonographic signs which can be used to distinguish atelectasis from pneumonia. In 2014, Ponsonnard et al. described the value of LU to control right DLT location in 23 patients.[3] They found that for a diagnosis of left lung isolation, sensitivity (S), specificity (E) and negative and positive predictive values (NPV and PPV) of sonography were 100%. The S of sonographic diagnosis of the right upper lobe (RUL) isolation was 91.67%, E was 100%, NPV and PPV were 91.67% and 100%, respectively.

According to them, an isolated RUL cannot be detected when high tidal volumes are used. The hyper insufflation of the lung can reveal LS when actually, it does not exist. Another condition of false positivity (FP) was described by Kaldirim et al.[4] They reported how LS might be a cause of of FP in an oesophageal intubation. They attributed it to a high thoracic pressure induced by increased air in the stomach.

LS depends on pulmonary compliance and tidal volume. To solve that problem, one can use a power colour Doppler technique by power slide sign. However, this is time-consuming and it requires some technical skill.[5] On the other hand, LP sign is more commonly seen on the left hemithorax than the right due to the proximity of the heart.

For these reasons, one can use a combination between diaphragmatic motion, LS and LP to improve the accuracy of LU to confirm the position of any kind of endotracheal tube.[6] Second, bronchial blockers should be placed under visual guidance of fibreoptic bronchoscope, as a suggestion made by manufacturers and medical literature. To sum up, more studies are needed to determine the role of LU for detecting acute selective lobar atelectasis in thoracic anaesthesia.

 
   References Top

1.
Parab SY, Divatia JV, Chogle A. A prospective comparative study to evaluate the utility of lung ultrasonography to improve the accuracy of traditional clinical methods to confirm position of left sided double lumen tube in elective thoracic surgeries. Indian J Anaesth 2015;59:476-81.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.
Acosta CM, Maidana GA, Jacovitti D, Belaunzarán A, Cereceda S, Rae E, et al. Accuracy of transthoracic lung ultrasound for diagnosing anesthesia-induced atelectasis in children. Anesthesiology 2014;120:1370-9.  Back to cited text no. 2
    
3.
Ponsonnard S, Karoutsos S, Gardet E, Marsaud JP, Nathan N. Value of lung sonography to control right-sided double lumen endotracheal location. J Anesth Clin Res 2014;5:453.  Back to cited text no. 3
    
4.
Kaldirim U, Tuncer SK, Eyi YE, Aksoy Y. Does ultrasonographic lung sliding sign always verify the success in endotracheal tube intubation? Am J Emerg Med 2014;32:472.  Back to cited text no. 4
    
5.
Islam NB, Levy PD. Emergency bedside ultrasound to detect pneumothorax. Acad Emerg Med 2003;10:819-20.  Back to cited text no. 5
    
6.
Blaivas M, Tsung JW. Point-of-care sonographic detection of left endobronchial main stem intubation and obstruction versus endotracheal intubation. J Ultrasound Med 2008; 27:785-9.  Back to cited text no. 6
    




 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    References

 Article Access Statistics
    Viewed1327    
    Printed7    
    Emailed0    
    PDF Downloaded258    
    Comments [Add]    

Recommend this journal