Bronchial lumen is the safer route for an airway exchange catheter in double-lumen tube replacement: preventable complication in airway management for thoracic surgery.

There is no current consensus on which lumen an airway exchange catheter (AEC) should be passed through in double-lumen endotracheal tube (DLT) to exchange for a single-lumen endotracheal tube (SLT) after thoracic surgery. We report an unusual case to provide possible solution on this issue. A 71-year-old man with lung adenocarcinoma had an event of a broken exchange catheter used during a DLT replacement with a SLT, after a video-assisted thoracic surgery. The exchange catheter was impinged at the distal tracheal lumen and snapped during manipulation. All three segments of the catheter were retrieved without further airway compromises. Placement of airway tube exchanger into the tracheal lumen of double-lumen tube is a potential contributing factor of the unusual complication. We suggest an exchange catheter be inserted into the bronchial lumen in optimal depth with the adjunct of video laryngoscope, as the safe method for double-lumen tube exchange.

[1]  T. Mort,et al.  Conventional Versus Video Laryngoscopy for Tracheal Tube Exchange: Glottic Visualization, Success Rates, Complications, and Rescue Alternatives in the High-Risk Difficult Airway Patient , 2015, Anesthesia and analgesia.

[2]  P. Slinger,et al.  A Simulator Study of Tube Exchange with Three Different Designs of Double-Lumen Tubes , 2014, Anesthesia and analgesia.

[3]  S. Kheterpal,et al.  Airway Exchange Failure and Complications with the Use of the Cook Airway Exchange Catheter®: A Single Center Cohort Study of 1177 Patients , 2013, Anesthesia and analgesia.

[4]  E. O'sullivan,et al.  Difficult Airway Society guidelines for the management of tracheal extubation , 2013, Anaesthesia.

[5]  R. Cooper,et al.  Extubation and Reintubation of the Difficult Airway , 2012, Benumof and Hagberg's Airway Management.

[6]  K. Takabe,et al.  Pneumothorax, an underappreciated complication with an airway exchange catheter. , 2012, Journal of thoracic disease.

[7]  M. Chalhoub,et al.  Endotracheal tube exchangers: should we look for safer alternatives? , 2012, Heart & lung : the journal of critical care.

[8]  A. Higgs,et al.  Re‐intubation over airway exchange catheters – mind the gap , 2010, Anaesthesia.

[9]  S. Neustein,et al.  Tracheal laceration after the use of an airway exchange catheter for double-lumen tube placement. , 2007, Journal of Cardiothoracic and Vascular Anesthesia.

[10]  M. Reay,et al.  Unforeseen esophageal misplacement of airway exchange catheter leading to gastric perforation. , 2006, Anesthesiology.

[11]  A. Baraka Tension pneumothorax complicating jet ventilation via a cook airway exchange catheter. , 1999, Anesthesiology.

[12]  J. Benumof Airway exchange catheters: simple concept, potentially great danger. , 1999, Anesthesiology.

[13]  R. Cooper The use of an endotracheal ventilation catheter in the management of difficult extubations , 1996, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[14]  M. Hannallah Evaluation of Tracheal Tube Exchangers for replacement of double-lumen endobronchial tubes. , 1992, Anesthesiology.

[15]  M. Bishop,et al.  Lung laceration after tracheal extubation over a plastic tube changer. , 1991, Anesthesia and analgesia.

[16]  J. Benumof,et al.  The effective tracheal diameter that causes air trapping during jet ventilation. , 1990, Journal of cardiothoracic anesthesia.

[17]  N. Gravenstein,et al.  Endobronchial rupture from endotracheal reintubation with an endotracheal tube guide. , 1989, Journal of clinical anesthesia.