Identifying Imminent Displacement of a Double-Lumen Tube Caused by Surgical Traction at the Pulmonary Hilum

Pfitzner, J.; Stevens, H.J.; Lance, David

doi:10.1053/j.jvca.2006.07.011

Cited by 3 publications

(3 citation statements)

References 6 publications

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“…The dislodgement of a double-lumen tube (DLT) caused by the surgeon's operation is not very uncommon. DLT displacement usually occurs when surgery is difficult and involving traction at the hilum [12]. Any attempt to ventilate the patient during the tube's relocation to its correct position will almost certainly result in expansion of the operated lung; this in itself can create a clinical emergency.…”

Section: Discussionmentioning

confidence: 99%

Use of an Emergency Manual During an Intraoperative Pulmonary Arterial Rupture, Hypoxemia, and Bradycardia

Huang

Guo

et al. 2020

Cureus

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The use of an emergency manual can improve team performance on critical steps during crisis events. Measures of improved performance have so far been captured through survey and simulation data; however, real-life case studies showing successful use of the manuals are fewer in number. The case of a patient with an unexpected rupture of the pulmonary artery, hypoxemia, and bradycardia during a video-assisted thoracic surgery lobectomy is described here. Relevant sections of Stanford University Operating Room Emergency Manuals were activated immediately and used during the rescue. The team of surgeons, anesthesiologists, and nurses managed the crisis in an orderly, smooth, and efficient manner, and the patient recovered without any complication. The use of the emergency manual reinforced by regular simulation-based training benefited the team and ultimately, the patient's safety.

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Section: Discussionmentioning

confidence: 99%

Use of an Emergency Manual During an Intraoperative Pulmonary Arterial Rupture, Hypoxemia, and Bradycardia

Huang

Guo

et al. 2020

Cureus

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“…A left-sided DLT is usually preferred in most thoracic surgeries because of a greater risk of upper lobe obstruction with a right-sided DLT [1]. However, even well-positioned DLTs with an appropriately inflated endobronchial cuff are known to get displaced during a change in patient position and surgical manipulation of the bronchus [2–5]. Left-sided polyvinyl chloride (PVC) DLTs are recommended to have the upper edge of the endobronchial cuff be seen at least 5 mm below the tracheal carina in the left main bronchus by fiberoptic bronchoscopy [6,7].…”

Section: Introductionmentioning

confidence: 99%

Comparison of displacement of polyvinyl chloride and silicone leftsided double-lumen tubes during lateral positioning

Kwon

Jung

Park

et al. 2019

Korean J Anesthesiol

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“…Second, its use enables the reliable and early identification of both small and larger volume gas leakage past the bronchial cuff, with a large leak resulting in a progressive expansion of the reservoir bag over a number of ventilations 4 , while a small gas leak can be identified by pressing an ear against the reservoir bag to hear the unmistakeable sound of gas escaping past a tight restriction 4,24 . This effective auditory conduit to the airways of both the non-ventilated and the ventilated lung also enables identification of imminent displacement of the DLT caused by surgical traction at the pulmonary hilum during a thoracotomy 25 .…”

mentioning

confidence: 99%

The role of an ambient pressure oxygen source during one-lung ventilation for thoracoscopic surgery

Pfitzner

2016

Anaesth Intensive Care

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Video-assisted thoracoscopic surgery is facilitated by prompt collapse of the non-ventilated (‘operated’) lung, and interrupted and impeded if there is a need for oxygen (O2) delivery by continuous positive airways pressure in order to manage hypoxaemia. It has been proposed that connecting an ambient pressure O2 source to the airway of the non-ventilated lung at the time one-lung ventilation is initiated and before the chest is opened will, by avoiding entrainment of ambient nitrogen, serve to facilitate lung collapse. It has also been proposed that leaving the O2 source connected will enable, not only ongoing apnoeic oxygenation before the chest is opened, but also the thoracoscopic procedure to commence with the operated lung fully pre-oxygenated (with an inspired oxygen fraction of 1), and apnoeic oxygenation to continue throughout the operative procedure in those patients who exhibit a degree of small airways patency at ambient pressure. In reality, several factors can influence the speed of collapse of the operated lung, and very many factors can influence the incidence of hypoxaemia during one-lung ventilation. It therefore appears unlikely that the necessary evidence to support these proposals will be forthcoming from randomised clinical studies on large numbers of patients. Rather, the necessary evidence may only be provided by specifically designed within-patient clinical measurement studies. Nevertheless, it is argued that, in the meantime, there is already sufficient rationale for an ambient pressure O2 source to be connected to the airway of the non-ventilated lung, and for it to remain connected for the duration of one-lung ventilation.

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Identifying Imminent Displacement of a Double-Lumen Tube Caused by Surgical Traction at the Pulmonary Hilum

Cited by 3 publications

References 6 publications

Use of an Emergency Manual During an Intraoperative Pulmonary Arterial Rupture, Hypoxemia, and Bradycardia

Use of an Emergency Manual During an Intraoperative Pulmonary Arterial Rupture, Hypoxemia, and Bradycardia

Comparison of displacement of polyvinyl chloride and silicone leftsided double-lumen tubes during lateral positioning

The role of an ambient pressure oxygen source during one-lung ventilation for thoracoscopic surgery

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