Airway rupture from double-lumen tubes.

A DOUBLE-CUFFED double-lumen endobronchial tube (DLT) was used for the first time during thoracic surgery almost 50 years ago to isolate and selectively ventilate the lungs. The benefits of DLTs in terms of improved surgical exposure mad their ability to isolate and protect the lungs during thoracic operations are now widely recognized. Although DLTs are safe and easy to use, complications occur. Table 1 lists the complications associated with DLTs. The most common problems involve tube placement. Rarely, the trachea or bronchus is injured, and even then, trauma to the airway is usually minor, resulting in laryngitis or tracheal irritation. More serious airway damage was a recognized complication of the original red rubber (RR) DLTs. When the softer plastic polyvinylchloride (PVC) DLTs were introduced in the early 1980s, it was initially befieved that these tubes were safer than RR tubes. 1,2 However, reports of airway injury from PVC DLTs soon appeared. The medical literature on airway disruption with DLTs was reviewed to try to identify factors associated with this potentially devastating complication.