Use of a Modified Single-lumen Endobronchial Tube in Severe Tracheobronchial Compression

Harte, B. H.; Jaklitsch, Michael T.; McKenna, Shannon S.; Body, Simon C.

doi:10.1097/00000542-200202000-00042

Cited by 8 publications

(3 citation statements)

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“…Other case reports describe other unique methods for intubation in mediastinal masses. 17,33 Because mediastinal masses may lead to rapid decompen sation and often require expertise from multiple specialties, many authors recommend preoperative interdisciplinary huddles to optimize perioperative outcomes for both adult and pediatric patients. 3,8,12,15,17 Our case clearly underlines the need for interdisciplinary planning.…”

Section: Discussionmentioning

confidence: 99%

Resection of a Posterior Mediastinal Mass in a 4-Year-Old Child Complicated by Difficult Airway Management and Emergent Use of Extracorporeal Membrane Oxygenation

Marsh

Benkwitz

2020

Semin Cardiothorac Vasc Anesth

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Literature on posterior mediastinal masses is limited. Furthermore, they have traditionally been described to pose lower cardiopulmonary risks compared with anterior mediastinal masses. Studies on posterior mediastinal masses are even more limited in the pediatric population. We present a case of a large posterior mediastinal mass in a 4-year-old child who presented with extremely difficult airway management during endobronchial intubation due to severe external compression that led to use of an adapted airway management technique with a rigid airway exchanger for lung isolation. Due to the pathology of the mass, a tracheal tear was encountered during surgical dissection and the patient required emergent venovenous extracorporeal membrane oxygenation to allow for successful airway repair and complete resection of the mass.

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Section: Discussionmentioning

confidence: 99%

Resection of a Posterior Mediastinal Mass in a 4-Year-Old Child Complicated by Difficult Airway Management and Emergent Use of Extracorporeal Membrane Oxygenation

Marsh

Benkwitz

2020

Semin Cardiothorac Vasc Anesth

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“…The authors additionally describe considering the use of an endobronchial stent but mention uncertainty in its efficacy or long-term risks [4]. In the anesthesia 3 Case Reports in Pulmonology literature, mediastinal masses often create airway obstruction, which are managed with the use of endobronchial tubes [5]. Whether a single lumen endobronchial tube advanced up to the left bronchus could have been used to decompress the airway and overcome this obstruction to provide better ventilation remains unclear.…”

Section: Discussionmentioning

confidence: 99%

One Lung Soldier: A Ventilation Conundrum in a Postpneumonectomy Syndrome Complicated by Acute Respiratory Syndrome

Purewal

Sakul

Balabbigari

et al. 2020

Case Reports in Pulmonology

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Postpneumonectomy syndrome involves mediastinal shift causing dynamic airway obstruction via compression of the main bronchus and distal trachea. A few case reports describe the development of ARDS in patients with postpneumonectomy syndrome. Reeb et al. (2017) describe the mortality of postpneumonectomy ARDS anywhere from 33% to 88%. One may encounter difficulty in intubation and ventilation as parameters based on ideal body weight may not apply. Prone positioning ventilation and ECMO have been successfully used in isolated cases. We present such a case and highlight challenges in management. A 70-year-old male Vietnam veteran with remote history of right pneumonectomy thirty years prior presented with fever, cough, and dyspnea. Physical exam was significant for T 36.3°C, BP 162/73, heart rate 145 BPM, RR 22 breaths/minute, ht. 1.72 m, and wt. 78 kg, with transmitted right lung sounds and rhonchi on the left. Labs showed WBC 23.92/nL and procalcitonin 0.84 ng/mL. CXR showed left infiltrate and opacification of right hemithorax with right mediastinal shift. EKG showed atrial fibrillation. He was started on broad spectrum antibiotics for pneumonia, but deteriorated, and was intubated for respiratory distress from ARDS. Vasopressors were initiated for shock. Given the history of pneumonectomy, he was initially ventilated with lower tidal volumes (320 mL). However, incremental changes were made to tidal volumes, and ETT was repositioned several times for hypoxia. Epoprostenol and cisatracurium were also initiated. Positional changes would lead to sudden desaturation; hence, prone positioning ventilation was not done. He was not considered for ECMO due to his pneumonectomy status. Unfortunately, his condition worsened progressively and he expired. The guidelines for ARDS are well established. However, postpneumonectomy patients are unique as seen in our patient. It is unclear whether an endobronchial tube advanced into the left bronchus could have helped difficult airway management resulting from suspected postpneumonectomy syndrome as suggested by CXR. Higher tidal volumes were also unsuccessful in alleviating hypoxia and led to persistently elevated plateau pressures and driving pressures as high as 23, which was inconsistent with our goal of lung protective ventilation. Few case reports describe the successful use of prone positioning ventilation or ECMO in postpneumonectomy patients with ARDS. Although not well studied, low tidal volumes supported with ECMO may have been a favorable strategy for our patient.

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“…However, SLEBT can have role in particular clinical settings for airway management in the surgery of distal trachea and main bronchi and for lung separation in obese patients 10 . Modified SLEBT was successfully used for airway management in severe tracheobronchial compression 11 . Also, when dealing with difficult airway in emergency, SLEBT could be easier to place than double lumen tube and protect the lung more safely than BB because it is less prone to dislodgement 12 .…”

Section: Airway Compression With Posterior Mediastinal Massmentioning

confidence: 99%

Anesthetic Management of a Patient With Central Airway Compression Due to Posterior Mediastinal Mass

Sulen

Petani

Bačić

et al. 2016

ACC

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SUMMARY -Patients with mediastinal masses present unique challenge to anesthesiologists. Patients with anterior mediastinal masses have well documented cases of respiratory or cardiovascular collapse during anesthesia and in postoperative period. Masses in the posterior mediastinum have been traditionally regarded to carry a significantly lower risk of anesthesia related complications but cases of near fatal cardiorespiratory complications have been reported. We describe anesthetic management of a patient with posterior mediastinal mass compressing the trachea and the left main bronchus presented for left thoracotomy and tumor excision. The patient experienced pain and cough, and exhibited positional dyspnea. Airway was successfully secured with awake nasotracheal intubation and placement of single lumen endobronchial tube.

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Use of a Modified Single-lumen Endobronchial Tube in Severe Tracheobronchial Compression

Cited by 8 publications

References 0 publications

Resection of a Posterior Mediastinal Mass in a 4-Year-Old Child Complicated by Difficult Airway Management and Emergent Use of Extracorporeal Membrane Oxygenation

Resection of a Posterior Mediastinal Mass in a 4-Year-Old Child Complicated by Difficult Airway Management and Emergent Use of Extracorporeal Membrane Oxygenation

One Lung Soldier: A Ventilation Conundrum in a Postpneumonectomy Syndrome Complicated by Acute Respiratory Syndrome

Anesthetic Management of a Patient With Central Airway Compression Due to Posterior Mediastinal Mass

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