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Effect of lateral positioning on the bronchial cuff pressure of a left-sided double-lumen endotracheal tube during thoracic surgery: study protocol for a prospective observational study
  1. Eugene Kim1,
  2. In-Young Kim2,
  3. Sung-Hye Byun2
  1. 1 Department of Anesthesiology and Pain Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
  2. 2 Department of Anesthesiology and Pain Medicine, Catholic University of Daegu School of Medicine, Daegu, Republic of Korea
  1. Correspondence to Dr Sung-Hye Byun; stone0311{at}


Introduction Correct pressure is important when using a double-lumen endotracheal tube (DLT), especially in thoracic surgery. An inadequate bronchial cuff pressure (BCP) can cause air leak and interfere with visualisation of the surgical field, whereas an excessive pressure BCP can lead to cuff-related complications. Based on several reports that cuff pressure could alter after a positional change when using an endotracheal tube, we hypothesise that a change from the supine position to the lateral decubitus position, which is essential for thoracic surgery, would affect the BCP of the DLT.

Methods and analysis This prospective, single-centre, observational study will enrol 74 patients aged 18–70 years undergoing elective lung surgery from September 2018 to April 2019. The primary outcome will be the change in the ‘initially established BCP’ (maximum BCP not exceeding 40 cm H2O with no air leak in the supine position) after lateral decubitus positioning. BCP and air leak will be assessed in each patient position during inflation of the cuff with air in 0.5 mL increments from 0 to 3 mL. Secondary outcomes will include the incidence of BCP exceeding 40 cm H2O after the initial established value and that of a change in the smallest bronchial cuff volume without air leak after a change to the lateral position. The relationship between the change in BCP and airway pressure, compliance and body mass index after lateral positioning will be investigated.

Ethics and dissemination The study will be conducted in accordance with the Declaration of Helsinki and supervised by the Daegu Catholic University Medical Center institutional review board (study approval number CR-18–111). All patients will receive information about the study and will need to provide written informed consent before enrolment. The results will be presented at an international meeting and published in a peer-reviewed journal.

Trial registration number NCT03656406; Pre-results.

  • cuff pressure
  • double-lumen endotracheal tube
  • one lung ventilation
  • thoracic surgery
  • monitoring

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  • Contributors EK and S-HB drafted the manuscript. EK, I-YK and S-HB will be responsible for the screening and enrolment of patients. S-HB revised this manuscript and will supervise the study. All authors have read and approved the final version of this manuscript.

  • Funding This work will be supported by a grant from the Research Institute of Medical Science, Catholic University of Daegu (grant number 201809). The funder has no role in the study, including in the study design or the decision to submit this manuscript for publication. It will also have no involvement in management, analysis or interpretation of the data collected in the study.

  • Competing interests None declared.

  • Ethics approval The study protocol has been approved by the Daegu Catholic University Medical Center institutional review board (CR-18–111).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.