Wire-guided Endobronchial Blocker Research Articles

Endobronchial Blocker Placement for Lung Isolation in Children: A Simple Head Turn Technique.

Endobronchial blockers are frequently used for lung isolation in children <8 years of age. The aim of our report is to highlight the problem that we have encountered with the wire-guided endobronchial blocker (WEB), where the wire loop used to couple the blocker and the fiberoptic scope (FOS) may straddle the carina. We describe the "uncoupled head turn technique" that we have adopted to avoid this problem. If the coupled technique is deemed necessary, a method to keep the wire loop snug around the FOS is described to avoid the straddling problem.

Efficiency, Efficacy, and Safety of EZ-Blocker Compared with Left-sided Double-lumen Tube for One-lung Ventilation

Double-lumen tubes (DLTs) or bronchial blockers are commonly used for one-lung ventilation. DLTs are sometimes difficult or even impossible to introduce, and the incidence of postoperative hoarseness and airway injuries is higher. Bronchial blockers are more difficult to position and need more frequent intraoperative repositioning. The design of a Y-shaped bronchial blocker, the EZ-Blocker (Teleflex Life Sciences Ltd., Athlone, Ireland) (EZB), combines some advantages of both techniques. The objective of this study was to assess whether EZB performs clinically better than left-sided DLTs (Broncho-cath; Mallinckrodt, Athlone, Ireland) without causing more injury. Primary outcome was the frequency of initial malpositions. Eligible patients were adults scheduled for surgery requiring one-lung ventilation who met criteria for placement of both devices. In this parallel trial, 100 consecutive and blinded patients were assigned randomly using a computer-generated list to two groups. The incidence of malposition and ease and time of placement were recorded. Blinded assessors investigated quality of lung deflation, postoperative complaints, and damage to the airway. Placement of a DLT was unsuccessful twice. The incidence of initial malposition was high and comparable between EZBs (37 of 50) and DLTs (42 of 49) (P = 0.212). Placing single-lumen tubes and EZBs took more time but was rated easier. Quality of lung deflation was comparable. Fewer patients in the EZB group complained of sore throat at day 1. There was a higher incidence of tracheal hematoma and redness and bronchial hematoma in the DLT group. The EZB is an efficient and effective device for one-lung ventilation and causes less injury and sore throat than a DLT.

One-lung ventilation in a pediatric patient using a wire-guided endobronchial blocker for video-assisted thoracoscopic surgery - A case report -

Video-assisted thoracoscopic surgery (VATS) has advantages compared with open thoracotomy. One lung ventilation, is indispensible to VATS, commonly is accomplished with a double-lumen endotracheal tube. For infants and small children, there is no double-lumen endotracheal tube suitable, various modified techniques are used to achieve one lung ventilation. Recently introduced a small sized wire-guided endobronchial blocker gives us another choice of one lung ventilation for VATS in small children. Using a wire-guided endobronchial blocker and multiport adapter for young children under flexible bronchoscope, we provided one lung ventilation (OLV) during VATS successfully without complications.

How to achieve successful lung separation

ABSTRACTRecent advances in surgical techniques for thoracic, cardiac, and oesophageal surgery have led to an increased use of lung separation techniques. Currently, double-lumen endotracheal tubes (DLT) and bronchial blockers (an Arndt wire-guided endobronchial blocker, a Cohen Flexitip endobronchial blocker, or the Fuji Uniblocker) are used.1–3 Achieving successful lung separation relies on knowledge of the anatomical distances of the airway, flexible fibreoptic bronchoscopy techniques, and familiarity with left and right-sided DLTs and bronchial blockers.In general, lung isolation techniques are designed to: facilitate surgical exposure for cases involving the thoracic cavity, to prevent contamination of the contralateral lung in cases where pus or haemorrhage is present, and to establish airway continuity such as in a patient who presents with bronchopleural fistula and requires mechanical ventilation. Specific indications with bronchial blockers include: patients with difficult airways, patients with ...

This Month in Anesthesiology

This Month in Anesthesiology

This Month in Anesthesiology

This Month in Anesthesiology

Use of the Arndt wire-guided endobronchial blocker via nasal for one-lung ventilation in patient with anticipated restricted mouth opening for esophagectomy

Functional separation of the lungs may be accomplished by several methods. Patient with restricted mouth opening has limited options for one-lung ventilation. We report the use of wire-guided endobronchial blockade, a new tool for achieving one-lung ventilation in a patient with restricted mouth opening requiring nasotracheal, fiberoptic intubation for esophagectomy and reconstruction with gastric tube substitution.

An update on bronchial blockers during lung separation techniques in adults.

Techniques for one-lung ventilation (OLV) can be accomplished in two ways: The first involves the use of a double-lumen endotracheal tube (DLT). The second involves blockade of a mainstem bronchus (bronchial blockers). Bronchial blockade technology is on the rise, and in some specific clinical situations (e.g., management of the difficult airway during OLV or selective lobar blockade) it can offer more as an alternative to achieve OLV in adults. Special emphasis on newer information for the use of Fogarty embolectomy catheter as a bronchial blocker, the torque control blocker Univent, and the wire-guided endobronchial blocker (Arndt blocker) is included. Also this review describes placement, positioning, complications, ventilation modalities, and airflow resistances of all three bronchial blockers. Finally, the bronchial blockers can be used in many cases that require OLV, taking into consideration that bronchial blockers require longer time for placement, assisted suction to expedite lung collapse, and the use of fiberoptic bronchoscopy. The current use of bronchial blockers, supported by scientific evidence, dictates that bronchial blockers should be available in any service that performs lung separation techniques.

The wire-guided endobronchial blocker as a solution to provide one-lung ventilation when a double-lumen endotracheal tube is malpositioned

DOUBLE-LUMEN endotracheal tubes are the most commonly used tubes for lung isolation. The indications for use of bronchial blockers, such as the Univent single-lumen endotracheal tube with enclosed bronchial blocker (Fuji Systems Corporation, Tokyo, Japan),1 or the wire-guided endobronchial blocker (Cook Critical Care, Bloomington, IN)2, are debatable.3,4 The use of the wire-guided endobronchial blocker is reported for rescue in a patient who presented for thoracoscopy and for whom surgery was difficult because of an improperly positioned left-sided double-lumen endotracheal tube.

Use of the wire-guided endobronchial blocker for one-lung anesthesia in patients with airway abnormalities

ONE-LUNG VENTILATION (OLV) in the thoracic surgical patient can be achieved with the use of a double-lumen endotracheal tube (DLT) or bronchial blockade with a Univent tube (Vitaid LTD, Lewiston, NY), a Fogarty occlusion catheter (Edwards Lifesciences, Irvine, CA), or a wire-guided endobronchial blocker (Arndt blocker; Cook Critical Care, Bloomington, IN).1,2 OLV techniques may be complicated in these patients because of the uncommon occurrence of carcinoma of the pharynx, tongue, or epiglottis, which makes intubation difficult. In addition, some of these patients have received prior neck radiation therapy and extensive neck/tracheal surgery. All of these problems make the airway management more complex and challenging. The authors report 4 cases in which the upper and/or lower airway anatomy have been previously distorted because of surgery or radiation; in all cases successful OLV was achieved with the use of the Arndt blocker.

Single-Lung Ventilation in a Pediatric Patient Using a Pediatric Fiberoptically-Directed Wire-Guided Endobronchial Blocker

Single-Lung Ventilation in a Pediatric Patient Using a Pediatric Fiberoptically-Directed Wire-Guided Endobronchial Blocker

Comparison of the Effects among Three Methods of Bronchial Blockade in One Lung Ventilation

Background: This study compared the modified BronchoCath double-lumen endotracheal tube (DLT) with the Univent bronchial blocker and Arndt's wire-guided endobronchial blocker (WEB) to determine whether there were objective advantages of one over the other during anesthesia with one lung ventilation. Methods: Forty five patients having either thoracic or esophageal procedures were randomly assigned to one of three groups. Fifteen patients received a left-side DLT, 15 patients received a Univent tube, and 15 patients received a WEB. The following were studied: 1) time required to position each tube until satisfactory placement was achieved, 2) time required until lung collapse, 3) frequency of malpositions after initial placement with fiberoptic bronchoscopy, 4) surgical exposure ranked by surgeons blinded to type of tube used. Results: Statistically significant differences were observed in time required to place the tube or blocker between the WEB (263.6 76.0 s), DLT (146.4 57.7 s, P ＜ 0.0001) and Univent tubes (193.8 72.4 s, P = 0.0130). There were no significant differences in time to lung collapse, the frequency of malposition or surgical exposure. Conclusions: We conclude that the DLT, Univent tube, and WEB are useful for one lung anesthesia but it takes longer for the WEB to be placed safely than to place a DLT or Univent tube. The selection between the three tubes depends on type of surgery, difficulty of intubation, and familiarity of each tube by the anesthesiologist.

First Experience With Fiberoptically Directed Wire-Guided Endobronchial Blockade in Severe Pulmonary Bleeding in an Emergency Setting

We report the first use of a new wire-guided endobronchial blocker in a critical respiratory situation caused by localized pulmonary bleeding. During emergency management, it became increasingly difficult to ventilate a multiple-trauma patient with a conventional single-lumen tube because of massive bleeding through the bronchus of the left lower lobe. Using the Arndt endobronchial blocker set (William Cook Europe A/S; Bjaeverskor, Denmark), we were able to prevent the spread of hemorrhaging and achieved effective ventilation and marked improvement in gas exchange. This new device allows the effective blockade of an isolated lobe under direct bronchoscopy to buy time for further intervention.