An Evaluation of a Blind Rotational Technique for Selective Mainstem Intubation

Bair, Aaron E.; Doherty, Melissa; Harper, Richart W; Albertson, Timothy E

doi:10.1111/j.1553-2712.2004.tb00688.x

Cited by 7 publications

(7 citation statements)

References 9 publications

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“…Some authors have investigated selective lung intubation effectiveness in fresh cadaveric studies and real patients. [ 6 7 8 9 ] However, there are limited data in the literature on this subject. Since patients who need selective intubation might have a difficult airway, our study provides data with difficult airway conditions on selective intubation, which was never presented, to our knowledge.…”

Section: Discussionmentioning

confidence: 99%

Selective intubation with endotracheal tube introducer in difficult airway

Özerol

Şancı

Karakayali

et al. 2021

Turkish Journal of Emergency Medicine

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BACKGROUND: Selective lung intubation is a life-saving procedure in emergency departments. While various equipment can be used in selective lung intubation, most of this equipment is not readily available; therefore, single-lumen endotracheal intubations are performed for rapid interventions. MATERIALS AND METHODS: This study was designed as a randomized, prospective, cross-over study using the 90° rotation technique for selective intubation on a manikin model with and without endotracheal tube introducer (ETI) in difficult airway settings. Forty-six emergency physicians were included in the study. The primary outcome was evaluating time to selective intubations, and secondary outcomes were first and second attempt success rates and the self-perceived difficulty level of each method according to the participants. RESULTS: The mean time to the first successful endotracheal intubation was significantly longer for both right selective and left selective intubations with ETI utilization than without ([39.71 ± 9.83 vs. 21.86 ± 5.94 s], [P < 0.001]), ([42.2 ± 10.81 vs. 26.23 ± 7.97 s], [P < 0.001], respectively). The first-pass success rate did not differ for right selective intubation with or without an ETI (45/46 [97.8%] and 45/46 [97.8%], respectively). However, the first-pass success rate for left selective intubation was significantly higher with ETI as compared to without an ETI (30/46 [65.2%] and 13/46 [28.3%], respectively) (P < 0.001). CONCLUSIONS: While the success rates of right selective intubation were the same, the left selective intubation success rates with ETI are higher than the styletted endotracheal tube, which can be strong evidence for this method's applicability in practice. Expanding the use of ETI and increasing the experience of the practitioners can contribute to further success.

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Section: Discussionmentioning

confidence: 99%

Selective intubation with endotracheal tube introducer in difficult airway

Özerol

Şancı

Karakayali

et al. 2021

Turkish Journal of Emergency Medicine

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“…[1][2][3][4] When hemostasis cannot be achieved bronchoscopically, lung isolation techniques should be employed to allow time to arrange more definitive life saving measures. 2,[5][6][7] The current suppliers of ETTs do not possess tubes of sufficient length and caliber to address the variety of anatomic variations we encounter. For individuals with long thoraces or large airway diameters, this can be particularly problematic.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5] Selective lung intubation is a useful technique during this time to allow securing of the normal lung until more definitive therapies, such as embolization or surgery, can be performed. 2,[5][6][7] Presented here are 2 cases where selective lung intubations could not be accomplished with standard endotracheal tubes (ETTs) due to the anatomic variations of the patients.…”

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confidence: 99%

A Technique to Intubate a Single Lung Using Combined Endotracheal Tubes When a Standard Endotracheal Tube is Inadequate

Eagan

Rose²,

Gibbs

et al. 2007

Journal of Bronchology

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Massive hemoptysis is a life-threatening emergency encountered by bronchoscopists. Oftentimes stabilizing these patients requires use of selective lung intubation. We present 2 cases of massive hemoptysis secondary to malignancies. Both cases required an extralong endotracheal tube to accomplish selective lung isolation. We used a unique technique of constructing an extralong endotracheal tube from 2 regular endotracheal tubes at the bedside. The extralong endotracheal tube was guided bronchoscopically into the left mainstem bronchus allowing us to selectively intubate the patient's uninvolved lung. Given this ongoing experience, development of an array of extended length endotracheal tubes should be considered. Until that time comes, our technique may be useful to others in managing this very difficult clinical situation.

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“…15 Selective mainstem intubation can be achieved by rotating the ETT by 90 degrees toward the unaffected side once the tube has passed the vocal cords. 16 Alternatively, a fiber optic bronchoscope can be utilized to advance a single lumen ETT into the left main bronchus if the bleeding is from the right. However, for the bleeding originating from the left, a selective right main-stem intubation could lead to the right upper lobe collapse due to its proximity to the carina.…”

Section: Selective Bronchial Intubationmentioning

confidence: 99%

Life-Threatening Hemoptysis

Deshwal

Sinha

Mehta

2020

Semin Respir Crit Care Med

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Life-threatening hemoptysis (LTH) is any amount of hemoptysis that causes significant hemodynamic decompensation or respiratory distress which may lead to death if left untreated. While the amount of hemoptysis that qualifies as massive hemoptysis has continued to be debated, any amount between 100 to 1,000 mL/day is considered significant. Up to 15% cases of hemoptysis are LTH and need urgent life-saving intervention. Understanding of pulmonary vascular anatomy is of paramount importance to manage LTH. The goal of treatment lies in airway protection, appropriate oxygenation, and prevention of exsanguination. Once the airway is stabilized, a quick diagnosis and control of bleeding site is targeted. This chapter highlights current practices and approach to LTH including medical management, bronchoscopic approach, and advanced therapies such as bronchial artery embolization and surgical resection. We review situations, such as bronchiectasis, vascular malformation, diffuse alveolar hemorrhage, and tracheostomy bleed and specific approach to management of these conditions in a systematic and evidence-based manner.

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An Evaluation of a Blind Rotational Technique for Selective Mainstem Intubation

Abstract: In a cadaveric model, the left mainstem bronchus can be selectively intubated with moderate reliability using this rotational technique. Use of a DTET confers no significant advantage. The ability to generalize these findings to living subjects is unknown.

Cited by 7 publications

References 9 publications

Selective intubation with endotracheal tube introducer in difficult airway

Selective intubation with endotracheal tube introducer in difficult airway

A Technique to Intubate a Single Lung Using Combined Endotracheal Tubes When a Standard Endotracheal Tube is Inadequate

Life-Threatening Hemoptysis

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