Selective Endobronchial Intubation Research Articles

Simulated dimensional compatibility of uncuffed and cuffed tracheal tubes for selective endobronchial intubation in children.

Cuffed tracheal tubes have recently been recommended for selective endobronchial intubation to establish single-lung ventilation even in smaller children. This implies that, compared with uncuffed tracheal tubes, the cuffed tracheal tubes selected will be smaller and therefore have a shorter length. We hypothesized that cuffed tracheal tubes might be of insufficient length for selective endobronchial intubation if the tube cuff were fully immersed in the left or right mainstem bronchus. The distance from the proximal end of the tracheal tube to the upper border of the cuff in cuffed tracheal tubes and to the upper margin of the Murphy eye in uncuffed tracheal tubes, respectively, was assessed in sizes 3.0-7.0mm internal diameter. The raw data sets of two previously performed studies obtained from 337 children aged from birth to 16years, including the distances "teeth to tracheal tube tip" and "tracheal tube tip to carina," were used to calculate age-, weight-, and height-related data for the distance from "teeth to carina." Tracheal tube dimensions were compared with age-related distances from "teeth to carina," applying published recommendations for the selection of uncuffed and cuffed tracheal tubes for selective endobronchial intubation in children. The differences between the length of the age-related tracheal tube and the tracheal tube insertion length required to guarantee full insertion of the tracheal tube cuff or the Murphy eye within the mainstem bronchus ranged from -3.5 to 52.6mm in cuffed tracheal tubes and from 42.3 to 83.3mm in uncuffed tracheal tubes. For many age groups of patients requiring selective endobronchial intubation, the lengths of cuffed tracheal tubes, in contrast to those of uncuffed tracheal tubes, were revealed to be critically short for safe taping outside the oral cavity with the cuff placed completely within the right or left mainstem bronchus.

Therapeutic bilateral lung lavage in a child with pulmonary alveolar proteinosis

Pulmonary alveolar proteinosis is a rare condition that can cause life-threatening respiratory failure attributable to excessive alveolar accumulation of surfactant proteins. The standard treatment for removing these secretions is through therapeutic bilateral lung lavage. Descriptions of procedures for performing therapeutic bilateral lung lavage and methods used to evaluate the overall effectiveness of this invasive procedure in children with pulmonary alveolar proteinosis have not been adequately described in the medical literature. We successfully and safely performed therapeutic bilateral lung lavage and obtained lung mechanics measurements in a child with pulmonary alveolar proteinosis. Case report. Operating room within a pediatric hospital. A 13-yr-old boy with pulmonary alveolar proteinosis requiring serial therapeutic bilateral lung lavage for recurrent respiratory distress. The patient presented to the hospital operating room for therapeutic lung lavage after a recent history of progressive dyspnea, respiratory distress, declining lung function measurements, and worsening radiographic abnormalities. We obtained baseline spirometric and respiratory system compliance measurements before and after therapeutic bilateral lung lavage. The left lung was lavaged on the first day and the right lung was lavaged on the third day using selective endobronchial intubation and selective lung ventilation. The procedure was well-tolerated and resulted in the removal of a significant volume of accumulated secretions. After the lavage, the patient demonstrated improvement in respiratory distress, chest radiograph appearance, lung compliance, and spirometric measurements. This case report demonstrates that therapeutic bilateral lung lavage can be performed safely and effectively in a pediatric patient with pulmonary alveolar proteinosis by isolating individual lungs using a dual-lumen endotracheal tube. In this patient, therapeutic bilateral lung lavage was found to have a significant impact on lung function and mechanics after this procedure.

Bronchopleural Cutaneous Fistula

Bronchopleural Cutaneous Fistula We report the imaging findings of a 60-year-old man who presented to our institution with dyspnea and sepsis. He had undergone neoadjuvant radiation therapy and a left lobectomy 3 years previously for a non-small-cell lung carcinoma. He had been well at follow-up in another institution but recently developed worsening dyspnea. CT of the thorax was performed (Fig. 1), which revealed a bronchopleural cutaneous fistula. This is a very rare late complication of lung resection for tumors and aspergillomas [1]. Patients complain of the unusual ability of being able to breathe with their upper airway occluded, and recurrent sepsis is of significant morbidity. Treatment includes endobronchial balloon occlusion and selective endobronchial intubation [1, 2]. This case highlights the vivid clinical picture that multiplanar reconstruction with MDCT can evoke. Ailbhe O’Neill Peter Beddy St. James’s Hospital Trinity College Dublin, Ireland DOI:10.2214/AJR.07.3441 WEB—This is a Web exclusive article.

Bronchial Injury During Lung Isolation in a Pediatric Patient

Bronchial Injury During Lung Isolation in a Pediatric Patient

Lower airway injuries and anaesthesia.

The perioperative management of lower airway injuries is a difficult clinical problem. Since few reviews present the management of this injury from an anaesthetic perspective, we undertook a literature review of this topic. A computerized search of the National Library of Medicine database using tracheal or bronchial injury as key words produced 140 English language citations. An eight-year chart review outlining our experience in an urban Canadian setting is also presented. The most frequent findings in patients with injury to the lower airway are dyspnoea and surgical emphysema. Other findings include cough, haemoptysis, sucking neck or chest wounds, mediastinal emphysema or pneumothorax. Endoscopy with a fiberoptic scope is the technique of choice for diagnosis, airway management and as a preparatory step in planning of the surgical repair. An airway technique employing direct vision is preferable to blind attempts during tracheal intubation. The use of a double lumen endobronchial tube or selective endobronchial intubation may be needed to achieve adequate pulmonary ventilation. A number of prospective randomized clinical trials comparing conventional mechanical ventilation with high frequency jet ventilation in patients with acute lung injury have demonstrated no difference in effectiveness of ventilation or oxygenation. Patients with lower airway injuries usually present when they are least expected and are a challenge to manage. The clinical presentation of a lower airway injury may be overt or subtle. Resuscitation and anaesthetic management are directed towards control of the airway, maintenance of adequate pulmonary ventilation and management of blood loss.

Intubation bronchique sélective à répétition au cours d'une cholécystectomie cœlioscopique

Selective endobronchial intubation occurred three times in a 38-year-old female patient undergoing laparoscopic cholecystectomy. She weighed 58 kg and was 165 cm tall. Anaesthesia was obstained with propofol, fentanyl and vecuronium. Endotracheal intubation was carried out with a Malinckrodt tube, size 7.5. It was attached to the cheeks with the 22 cm marking at the teeth. The diagnosis of endobronchial intubation was made when he SpO 2 fell abruptly to 79, 87 and 93 % respectively. Simultaneously, the peak inspiratory pressure increased and Petco 2 decreased. The third time, both lung fields were ausculated ; no breath sounds were found on the left side. The first two incidents were cured by exsufflating the artificial pneumoperitoneum. Pulling out the tube 4 cm definitely solved the problem. These endobronchial intubations were due to the tube being too close to the carina. During insufflation of the pneumoperitoneum, the carina is pushed upwards with the corresponding part of the mediastinum.

Type IV laryngotracheoesophageal cleft in a neonate

SummaryThe peri‐operative management of a neonate with type IV laryngotracheoesophageal cleft, microgastria and pulmonary hypoplasia is described. Bronchoscopy was necessary to delineate the extent of the defect and was useful for performing selective endobronchial intubation. Chronic aspiration and atelectasis complicated the post‐operative management. Endobronchial intubation is compared with the use of a double lumen tube and tracheostomy for intra‐operative ventilation.

Neonatal Lung Abscess: Resection Using One-Lung Anesthesia

Three neonates with lung abscess unresponsive to antibiotic therapy underwent successful resection of infected lobes with the aid of one-lung anesthesia. This was accomplished by selective endobronchial intubation of the opposite lung and obstruction of the ipsilateral main bronchus with a Fogarty balloon-tipped catheter. This valuable technique provides protection against tracheobronchial spillage of purulent material and results in the rapid recovery of these seriously ill neonates.

Successful Diagnosis and Management of Fistulas Between the Aorta and the Tracheobronchial Tree

The patient presented in this report is unique in that he survived two aortobronchial fistulas. With such fistulas, intermittent hemoptysis is always present; pain is an infrequent symptom. Plain roentgenograms of the chest are helpful in denoting the presence of an aneurysm and the affected portion of the tracheobronchial tree. Aortography rarely demonstrates the fistula. Bronchoscopy should be conducted only with care when the diagnosis is in doubt since disaster can attend disruption of the clot in the fistula. Successful repair usually requires maintenance of distal circulation, repair of the aorta either by closure or by graft replacement, and repair of the tracheobronchial tree either by resection or primary suture. Anesthesia management should include selective endobronchial intubation to control possible intraoperative hemorrhage. Interposition of healthy living tissue to protect the suture lines is encouraged to prevent recurrence.