An interventional study of Right Tracheal Displacement and Right Head Turn Maneuver in Double-Lumen Endotracheal Tube Placement, sponsored by Taipei Veterans General Hospital, Taiwan. Completed at 1 site in Taiwan. Per ClinicalTrials.gov, last updated 2026-08-10.
Sponsored by Taipei Veterans General Hospital, Taiwan · Not applicable, Interventional, and Basic science
This study evaluated how simple external airway maneuvers affect the alignment of the left main bronchus during placement of a left-sided double-lumen endotracheal tube. Adults undergoing elective thoracic surgery requiring one-lung ventilation were enrolled.
During double-lumen tube placement, a fiberoptic bronchoscope was used to continuously view the airway. Each participant underwent three sequential maneuvers: rightward displacement of the trachea, turning the head 45 degrees to the right, and turning the head 45 degrees to the left. The investigators measured how far the opening of the left main bronchus moved on the bronchoscopic image and whether it crossed the center of the image.
The purpose of the study was to determine how these maneuvers change airway alignment and whether they may help guide a left-sided double-lumen tube toward the left main bronchus.
Exclusion Criteria:
Participants underwent three airway maneuvers in a predefined sequence during left-sided double-lumen tube placement: right tracheal displacement, 45° right head turn, and 45° left head turn. The airway and head position were returned to neutral between maneuvers. Bronchoscopic alignment and horizontal displacement of the left main bronchus were assessed during each maneuver.
Procedure: Right Tracheal Displacement · Procedure: Right Head Turn Maneuver · Procedure: Left Head Turn Maneuver
A lateral force was applied externally at the left cricothyroid level to displace the trachea toward the right. The force was increased until maximal bronchoscopic displacement was observed. Peak applied force was recorded using a digital force gauge. Bronchoscopic alignment and horizontal displacement of the left main bronchus were assessed during the maneuver.
The participant's head was rotated 45° to the right from the neutral position. Bronchoscopic alignment and horizontal displacement of the left main bronchus were assessed during the maneuver. The head was subsequently returned to the neutral position.
The participant's head was rotated 45° to the left from the neutral position. Bronchoscopic alignment and horizontal displacement of the left main bronchus were assessed during the maneuver. The head was subsequently returned to the neutral position.
Midline Crossing of the Left Main Bronchus
Midline crossing was defined as a change in the position of the left main bronchus from the left side to the right side of the midline of the bronchoscopic image following each airway maneuver. The position of the left main bronchus was assessed using real-time fiberoptic bronchoscopy with the bronchoscope maintained 2 cm proximal to the carina. Midline crossing was recorded as a binary outcome (yes/no) for each maneuver.
Time frame: During the airway maneuver, immediately after each maneuver was applied
Relative Horizontal Displacement of the Left Main Bronchus
Relative horizontal displacement was defined as the difference in the horizontal position of the left main bronchus before and during each airway maneuver, expressed as a percentage (Δ%) of the total width of the bronchoscopic image. The right edge of the left main bronchus was used as the reference point. Positive values indicated rightward displacement and negative values indicated leftward displacement. Measurements were obtained from bronchoscopic images with the bronchoscope maintained 2 cm proximal to the carina.
Time frame: During the airway maneuver, immediately after each maneuver was applied
Plan to share: Yes — De-identified individual participant data underlying the results reported in the published article will be available upon reasonable request to the corresponding author, subject to institutional and ethical requirements.
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Taipei Veterans General Hospital, Taiwan