Double-lumen tubes and bronchial blockers

Question 1

Indications for One Lung Ventilation

Answer 1

Absolute
- Managing air leak in the pleural space- bronchopulmonary fistula
- Preventing contamination of healthy lung- abscess, pulmonary haemorrhage

Relative
- Thoracic surgery
- Thoracic spine surgery
- Aorta surgery in the thorax
- Oesophageal surgery

Question 2

Double lumen tubes: Pros and Cons

Answer 2

Pros
- Quicker to place than bronchial blockers
- Can alternate ventilation to either lung
- Fibreoptic scope not essential

Cons
- Limited sizes available
- Difficult to place in abnormal anatomy
- Not good for prolonged post-op ventilation
- Higher risk of airway trauma

Question 3

Bronchial blockers: Pros and Cons

Answer 3

Pros
- Good for patient’s already ventilated or tracheostomy in-situ
- Good for difficult intubations
- Selective lobar isolation is possible
- Easily withdrawn if post-op ventilation is required

Cons
- Takes a long time to insert and needs a bronchoscope
- Cannot suction past the blocker
- More prone to displacement intra-operatively

Question 4

Indications for right-sided double lumen tube

Answer 4

• Surgery involving the left main bronchus: Left pneumonectomy, left lung transplant
• Proximal obstruction of the left main bronchus
• Severe distortion of the left main bronchus- compression from enlarged lt atrium, or thoracic aortic aneurysm

Question 5

Features of a malpositioned double-lumen tube

Answer 5

• High airway pressures
• Persistent ventilation of operative lung
• Abnormal capnograph trace
• Circuit leak
• Impaired gas exchange