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
Yijun Seo, Namo Kim, Hyo Chae Paik, Dahee Park, Young Jun Oh, Yijun Seo, Namo Kim, Hyo Chae Paik, Dahee Park, Young Jun Oh
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.
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References
- de Bellis M, Accardo R, Di Maio M, et al. Is flexible bronchoscopy necessary to confirm the position of double-lumen tubes before thoracic surgery? Eur J Cardiothorac Surg 2011;40:912–6.
- Klein U, Karzai W, Bloos F, et al. Role of fiberoptic bronchoscopy in conjunction with the use of double-lumen tubes for thoracic anesthesia a prospective study. Anesthesiology 1998;88:346–50.
- Kim SH, Choi YS, Shin S, et al. Positioning of double-lumen tubes based on the minimum peak inspiratory pressure difference between the right and left lungs in short patients: a prospective observational study. Eur J Anaesthesiol 2014;31:137–42.
- Jenkins AV. An endobronchial cuff indicator for use in thoracic surgery. Br J Anaesth 1979;51:905–6.
- Takita K, Morimoto Y, Kemmotsu O. The height-based formula for prediction of left-sided double-lumen tracheal tube depth. J Cardiothorac Vasc Anesth 2003;17:412–3.
- Campos JH. Which device should be considered the best for lung isolation: double-lumen endotracheal tube versus bronchial blockers. Curr Opin Anesthesiol 2007;20:27–31.
- Brodsky JB. Lung separation and the difficult airway. Br J Anaesth 2009;103 suppl:i66–75.
- Benumof JL. Difficult tubes and difficult airways. J Cardiothorac Vasc Anesth 1998;12:131–2.
- Campos JH, Hallam EA, Van Natta T, et al. Devices for lung isolation used by anesthesiologists with limited thoracic experience: comparison of double-lumen endotracheal tube, Univent torque control blocker, and Arndt wire-guided endobronchial blocker. Anesthesiology 2006;104:261–6.
Source: PubMed