Use of the Human Broncho® Double-Lumen Tube in a Tracheal Bronchus Patient After Failed Lung Isolation with a Broncho-Cath™: A Case Report.

Abstract

Airway management for one-lung ventilation may be challenging for anesthesiologists depending on the location of the tracheal bronchus orifice and possible anatomical distortions. Polyvinyl chloride double-lumen tube Broncho-Cath™ has been successfully used for one-lung ventilation in most cases of tracheal bronchus arising within 2 cm above the carina. However, there have been reports of occasional failure. A 78-year-old male patient diagnosed with secondary pneumothorax was scheduled for video-assisted thoracic surgery, and the tracheal bronchus originating 1.9 cm above the carina was shown in the preoperative chest computed tomography. Although a left-sided Broncho-Cath was initially placed, one-lung ventilation could not be achieved. Under bronchoscopy view through the tracheal lumen, the tracheal bronchus orifice was found to be partially obstructed. Furthermore, the bronchial cuff was herniated from the left main bronchus, leading to a failure of one-lung ventilation. The Broncho-Cath was replaced with a silicone double-lumen tube Human Broncho®, which has more flexible bronchial segment and an increased marginal gap between the bronchial cuff and the tracheal lumen opening. The Human Broncho was successfully placed in an optimal position within the left main bronchus without blocking the tracheal bronchus orifice, thereby achieving the successful one-lung ventilation. The structurally unique Human Broncho may be considered as an alternative option in thoracic surgery of tracheal bronchus patients if lung isolation cannot be achieved with the Broncho-Cath.