A Less Difficult Method to Protect the Tracheal Cuff of a Double-Lumen Tube

To the Editor:

I read with interest the letter by Coppa and Brodsky ^[1] describing a method to protect the cuffs of a double-lumen tube from damage. They emphasized the usefulness of their method during difficult intubations or for patients with prominent teeth. Although I believe that this method works, it seems complicated and requires assistance to remove the cuff protector. It also might distract or impair visualization of the cords, which would be especially disadvantageous during a difficult intubation. If the tape slips off due to secretions, it might also place the patient at risk of aspiration of a foreign body.

A more simple method to protect the cuff of a double-lumen tube, especially if the patient has prominent teeth, is to use a well lubricated teethguard and also to lubricate the cuffs of the double-lumen endotracheal tube. This provides a smooth gliding surface, thereby minimizing the risk of cuff damage while making it much easier to advance the double-lumen tube and assuring adequate tooth protection. This method does not require any additional help, needs minimal time and effort in preparation, and works well without making intubation more difficult.

Joachim M. Erb, MD, DEAA

Department of Anesthesiology; Emory University School of Medicine; Atlanta, GA 30322