Selective Left Bronchial Intubation and Left-Lung Isolation in Infants and Toddlers: Analysis of a New Technique

Chengod, Suressh; Chandrasekharan, Aluvangal P.; Manoj, Padmanabhan

doi:10.1053/j.jvca.2004.10.005

Cited by 16 publications

(12 citation statements)

References 15 publications

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“…As for the comparison between both devices, the pros of Univent tubes are more considerate insertion with suffi cient time for obturation, minimum manipulation in the refl exogenic zone around carina tracheae and the possibility of selective separation of the respective pulmonary lobes. It can be used even in considerably small children (16). Double-lumen tube allows for quick alternation between right and left lung separation through the closure of the appropriate connector arm, while Univent tube requires relocation of the obturator for other lung under fi brooptic control.…”

Section: Discussionmentioning

confidence: 99%

Selective lung intubation during paediatric thoracic surgeries

Mixa¹,

Nedomova²,

Rygl³

2016

BLL

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Selective lung intubation is a necessary prerequisite for the completion of most interventions comprising thoracotomy and thoracoscopy. In paediatric care, our site uses Univent tubes for children up to the age of three years and double-lumen tubes (DLT) for children from 6-8 years of age. In younger children, we usually use regular endotracheal intubation, with the lung being held in the hemithorax position being operated on using a surgical retractor. The article presents the analysis of 860 thoracic surgeries, of which 491 comprised selective intubation (Univent 57 cases, DLT 434 cases). The use of the aforementioned devices is connected with certain complications. Univent tube can be connected with intraoperative dislocation of the obturating balloon (29.8%) and balloon perforation (5.2%). DLT insertion may be connected with failure of tube fi tting. In 84 cases we had to repeat DLT insertion (20.6%). In 8 cases we were not able to insert DLT at all (1.8%). Standard use of selective intubation methods in paediatric patients from two years of age improved the conditions for surgical interventions (Tab. 2, Fig. 2, Ref. 19).

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Section: Discussionmentioning

confidence: 99%

Selective lung intubation during paediatric thoracic surgeries

Mixa¹,

Nedomova²,

Rygl³

2016

BLL

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“…BB products typically have been deployed within the ETT or intraluminally after intubation for one lung ventilation [2]. However, intraluminal placement of these devices sometimes can be challenging, with both the blocker and flexible fiberoptic bronchoscope (FOB) present within the ETT, especially the leftsided BB placement [3,4].…”

Section: Editorialmentioning

confidence: 99%

Easier Left Sided Bronchial Blocker Placement Using Middle Fixation of Endotracheal Tube and Real Time Wireless Video Fiberoptic Bronchoscopy

Lai

Lin

2019

BJSTR

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“…In addition, concerns have recently been raised with regard to pressures needed to expand the blocker balloons, which potentially might result in bronchial damage. 2,7,8…”

Section: Introductionmentioning

confidence: 99%

“…In daily clinical practice, bronchial blocker balloons demonstrate a delayed expansion of diameter when inflated with air, independently of whether they are tested unrestricted in air or inserted within a bronchus. In addition, concerns have recently been raised with regard to pressures needed to expand the blocker balloons, which potentially might result in bronchial damage 2,7,8 . Inflation pressures of 710 cm and 340 cm H 2 O, respectively, have been reported to result from injection of 2 ml of air into the 5 Fr Fogarty arterial embolectomy and the 5 Fr Arndt endobronchial blocker balloons 2 .…”

Section: Introductionmentioning

confidence: 99%

Inflation volume‐balloon diameter and inflation pressure‐balloon diameter characteristics of commonly used bronchial blocker balloons for single‐lung ventilation in children

Goetschi

Kemper

Kleine‐Brueggeney

et al. 2021

Pediatric Anesthesia

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Background: Balloon-tipped bronchial blocker catheters are widely used in pediatric thoracic anesthesia to establish single-lung ventilation. In clinical practice, their balloons demonstrate sudden expansion when inflated with air. In addition, there are concerns related to the high inflation pressures required to expand the balloons. Methods: This in vitro study assessed inflation volume-and inflation pressure-balloon diameter characteristics of the Fogarty arterial embolectomy catheters and Arndt endobronchial blockers. Balloon diameters were photographically assessed during unrestricted volume-and pressure-guided inflation, using air up to the maximum allowed inflation volume as indicated by the manufacturers. Inflation pressures required to open the blocker balloons and inflation pressures needed to expand them to maximum indicated diameter were measured. Results: Volume-guided inflation demonstrated a late acute rise in diameter in Fogarty blocker balloons, whereas in the Arndt endobronchial blocker balloons almost linear inflation volume-to-diameter characteristics were observed. Pressure-guided inflation on the other hand demonstrated low-volume, high-pressure characteristics in the Fogarty blocker balloons, with inflation pressures required to expand the balloons to maximum diameters ranging from (mean (SD)) 636 (75) to 947 (152) cmH 2 O. The inflation pressures required to open the Fogarty blocker balloons were even >1000 cmH 2 O. Inflation pressures required to expand the 5 F, 7 F, and 9 F Arndt endobronchial blocker balloons to maximum indicated diameter were much lower, namely at 218 (15), 252 (28), and 163 (8) cmH 2 O. Conclusion: Based on these study findings, the balloons of Fogarty arterial embolectomy catheters represent high-pressure devices and do not permit stepwise controlled bronchial blockage. The Arndt endobronchial blockers have some advantages over the Fogarty blocker devices, but also represent high-pressure equipment and must be used with caution and limited duration. Manufacturers are asked to design pediatric endobronchial blocker catheters with truly high-volume, low-pressure balloons in accordance to age-related pediatric airway dimensions.

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Selective Left Bronchial Intubation and Left-Lung Isolation in Infants and Toddlers: Analysis of a New Technique

Cited by 16 publications

References 15 publications

Selective lung intubation during paediatric thoracic surgeries

Selective lung intubation during paediatric thoracic surgeries

Easier Left Sided Bronchial Blocker Placement Using Middle Fixation of Endotracheal Tube and Real Time Wireless Video Fiberoptic Bronchoscopy

Inflation volume‐balloon diameter and inflation pressure‐balloon diameter characteristics of commonly used bronchial blocker balloons for single‐lung ventilation in children

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