Successful blind lung isolation with the use of a novel double-lumen endobronchial tube in a patient undergoing lung transplantation with massive pulmonary secretion: A case report

Abstract

Rationale: Precise lung isolation technique with visual confirmation is essential for thoracic surgeries to create a safe and clear surgical field. However, in certain situations, such as when patients have massive pulmonary secretion or when the fiberoptic bronchoscopy (FOB) is not applicable, lung isolation has been performed blindly.

Patient concern: A 52-year-old woman, whose airway was unable to visualize with FOB due to massive pulmonary secretion, was presented for bilateral sequential lung transplantation. Extracorporeal membranous oxygenation, tracheostomy, and mechanical ventilation were applied to the patient for 39 days preoperatively as a bridge for lung transplantation.

Diagnosis: Patient was diagnosed with an idiopathic pulmonary fibrosis and obesity.

Intervention: Initially, height-based blind positioning with a conventional double-lumen endobronchial tube (DLT) failed to ventilate the patient properly, and the confirmation of DLT positioning with FOB was impossible due to massive pulmonary secretion. Therefore, a novel DLT (ANKOR DLT) that has one more cuff, located at a point between the distal opening of the tracheal lumen and the starting point of bronchial cuff, than conventional DLT was used for the lung isolation in the patient.

Outcomes: After the completion of lung graft, FOB finding showed that the ANKOR DLT was optimally positioned at the tracheobronchial tree of the patient, and its depth was 2.5 cm shallower than that of the conventional tube.

Lessons: ANKOR DLT would be a feasible choice to achieve successful blind lung isolation when the use of FOB is impossible to achieve the optimal lung isolation.

Conflict of interest statement

YJO has the patent on the design of ANKORTM double-lumen endobronchial tube, and licenced it out to Insung Medical. Co. Other authors have no conflicts of interest.

Figures

Figure 1

Perioperative images of the patient. A, Preoperative chest x-ray, showing severe diffuse lung consodiation. B, Bronchoscopic finding, showing massive pulmonary secretion within the conventional double-lumen endobronchial tube.

Figure 2

The design of a novel double-lumen endobronchial tube (ANKOR DLT) and its application to the patient. A, Compared with conventional DLT, ANKOR DLT has one more cuff, “carinal cuff,” that is located at a point between the distal opening of the tracheal lumen and the starting point of bronchial cuff. B, Once the carinal cuff of the tube passed through the vocal cord of the patient, it was turned to the left, and carinal cuff was inflated with 6 mL of air. It was transiently supposed to form an inverted “Y” shape with the inflated carinal cuff and the distal part of bronchial lumen of the tube, which functionally anchored the tube at the keel-shaped carinal ridge. C, After the deflation of the carinal cuff, the tracheal cuff and the bronchial cuff of the tube were inflated with 5 and 2 mL of air, respectively. D, After the completion of right lung graft, bronchoscopic finding showed that the tube was properly positioned in the tracheobronchial tree of the patient showing the upper margin of the bronchial cuff was slightly seen at between the carina and the left main bronchial orifice without the obstruction of the tracheal lumen.