PP33 - Lung abscess isolation using double lumen tubes combined with bronchial blockers: a case series

Abstract

Thoracic surgery in patients with lung infections is an absolute indication to isolate healthy lung or lobes. Different methods have been described, including the double-lumen endotracheal tube (DLT) or a variety of bronchial blockers (BBs) (1). However, when an abscess is present in only one lobe and lobectomy is planned, the insertion of a DLT alone or a single tube plus a BB may not be sufficient to prevent the spread of infection to an ipsilateral lobe. We present three cases with lung infection in which the isolation was made by combining DLT with a BB. Case 1: 22-years-old man diagnosed with lung aspergilloma within the residual tuberculous cavity in the upper left lobe. The surgeon requested selective resection of this lobe. Case 2: 50-year-old man diagnosed with lung abscess in the left lower lobe with suspected neoplasia, proposed to lobectomy. Case 3: 45-year-old woman diagnosed with lung abscess in the left upper lobe with suspected neoplasia/infection, proposed for lobectomy. In all three cases, airway management was a combination of left DLT (two Robertshaw type DL and one VivaSight DL®) with a BB, using the flexible fiberoptic scope as a guide to place the BB to the lobe that was being isolated. In case 1 a Cohen BB was used; in case 2 and 3, an Arndt BB was chosen. After BB placement, the corresponding lobes were isolated, ventilation in the rest of the ipsilateral lung was initiated. The lobes remained isolated until the bronchus resection. In thoracic anaesthesia providing satisfactory surgical exposure and maintaining adequate oxygenation is a challenge. But in these cases, isolation was even more important. Several devices are used to perform lung/lobe isolation: some experts recommend DLT for its shorter insertion time and less need for repositioning; others suggest that the BB have lower complication rates with the same efficiency (2). However, in thoracic surgery involving lung abscess the combination of both devices (DLT and BB) provides excellent isolation and results. This method prevented the spread of infection to the healthy lung with the DLT and to non-affected areas of the ipsilateral lung with the BB during airway and surgical manipulation with a favourable clinical-surgical outcome. 1. Narayanaswamy M, et al. Choosing a lung isolation device for thoracic surgery: a randomized trial of three bronchial blockers versus double lumen tubes. Anest Analg 2009; 108(4):1097-101. 2. Clayton-Smith A, et al. A comparison of the efficacy and adverse effects of double lumen endobronchial tubes and bronchial blockers in thoracic surgery: A systematic review and meta-analysis of randomized controlled trials. J Cardiothorac Vasc Anesth 2015; 29(4):955-66.