Skip to main content
SpringerLink
Log in

Atemwegsmanagement zur Seitentrennung der Lunge bei thorakalen Eingriffen

Ein Update

Airway management for lung separation in thoracic surgery

An update

  • Leitthema
  • Published:
Der Anaesthesist Aims and scope Submit manuscript

Zusammenfassung

Eine der Hauptaufgaben im klinischen Alltag jedes Anästhesisten ist die Atemwegssicherung. Darunter fallen auch Techniken zur Lungenseparation und seitengetrennten Ventilation (Einlungenventilation) bei thoraxchirurgischen Eingriffen und in der Intensivmedizin. Dem Anästhesisten stehen dabei verschiedene Methoden zur Verfügung, um eine seitengetrennte Lungenventilation zu erreichen.

In diesem Artikel werden die aktuell üblichen Methoden zur Lungenseparation vorgestellt. Dazu gehören der klassische Doppellumentubus sowie die Bronchusblocker nach Arndt und Cohen, der EZ-Blocker, der Uniblocker, der Univent Tubus und der VivaSight-DL™. Die Effekte der Einlungenventilation werden dabei nicht näher beschrieben. Hierzu sei auf einschlägige Literatur verwiesen. Dieser Artikel soll insbesondere für Ärzte in der Weiterbildung, aber auch für Kollegen, die selten diese Verfahren einsetzen, einen Gesamtüberblick über die verschiedenen Möglichkeiten zur Lungenseparation bieten.

Abstract

One of the main tasks in every anesthetist’s routine clinical practice is securing the airway. This also includes techniques for lung isolation and one-lung ventilation in thoracic surgery and in intensive care medicine. The anesthesiologist has various methods available to achieve one-lung ventilation. This article presents the most commonly used methods for lung isolation. These include the double lumen tube, the bronchus blockers by Arndt and Cohen, the EZ blocker, the Uniblocker, the Univent tube and the VivaSight-DL™. The effects of the one-lung ventilation are not described in detail and for this the reader should refer to the appropriate literature. This article is intended to provide an overview of the various possibilities for lung separation, especially for physicians in continued medical education and also for physicians who rarely use these procedures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7
Abb. 8
Abb. 9
Abb. 10

Literatur

  1. Benumof JL (1985) One-lung ventilation and hypoxic pulmonary vasoconstriction: implications for anesthetic management. Anesth Analg 64:821–833

    Article  PubMed  CAS  Google Scholar 

  2. Szegedi LL (2001) Pathophysiology of one-lung ventilation. Anesthesiol Clin North America 19(3):435–453

    Article  PubMed  CAS  Google Scholar 

  3. Dunn PF (2000) Physiology of the lateral decubitus position and one-lung ventilation. Int Anesthesiol Clin 38:25–53

    Article  PubMed  CAS  Google Scholar 

  4. Motsch J, Wiedemann K, Roggenbach J (2005) Atemwegsmanagement bei der Ein-Lungen-Ventilation. Anaesthesist 54:601–622 (quiz 23–4)

    Article  PubMed  CAS  Google Scholar 

  5. Defosse J, Schieren M, Böhmer A et al (2016) Deutschlandweite Umfrage zur Thoraxanästhesie. Anaesthesist 65:449–457

    Article  PubMed  CAS  Google Scholar 

  6. Campos JH (2001) Lung isolation techniques. Anesthesiol Clin North America 19:455–474

    Article  PubMed  CAS  Google Scholar 

  7. Carlens E (1949) A new flexible double-lumen catheter for bronchospirometry. J Thorac Surg 18:742–746

    PubMed  CAS  Google Scholar 

  8. Bjork VO, Carlens E (1950) The prevention of spread during pulmonary resection by the use of a double-lumen catheter. J Thorac Surg 20:151–157

    PubMed  CAS  Google Scholar 

  9. Brodsky JB, Lemmens HJ (2007) The history of anesthesia for thoracic surgery. Minerva Anestesiol 73:513–524

    PubMed  CAS  Google Scholar 

  10. White GM (1960) A new double lumen tube. Br J Anaesth 32:232–234

    Article  PubMed  CAS  Google Scholar 

  11. Bryce-Smith R (1959) A double-lumen endobronchial tube. Br J Anaesth 31:274–275

    Article  PubMed  CAS  Google Scholar 

  12. Bryce-Smith R, Salt R (1960) A right-sided double lumen tube. Br J Anaesth 32:230–231

    Article  PubMed  CAS  Google Scholar 

  13. Robertshaw FL (1962) Low resistance double-lumen endobronchial tubes. Br J Anaesth 34:576–579

    Article  PubMed  CAS  Google Scholar 

  14. Burton NA, Watson DC, Brodsky JB, Mark JB (1983) Advantages of a new polyvinyl chloride double-lumen tube in thoracic surgery. Ann Thorac Surg 36:78–84

    Article  PubMed  CAS  Google Scholar 

  15. LMA (Hrsg) (2012) Effective one lung ventilation (OLV) with the Fuji Systems product range (Product overview)

    Google Scholar 

  16. Brodsky JB, Mackey S, Cannon WB (1997) Selecting the correct size left double-lumen tube. J Cardiothorac Vasc Anesth 11:924–925

    Article  PubMed  CAS  Google Scholar 

  17. Benumof JL, Partridge BL, Salvatierra C, Keating J (1987) Margin of safety in positioning modern double-lumen endotracheal tubes. Anesthesiology 67:729–738

    Article  PubMed  CAS  Google Scholar 

  18. Cohen E (2004) Double-lumen tube position should be confirmed by fiberoptic bronchoscopy. Curr Opin Anaesthesiol 17:1–6

    Article  PubMed  Google Scholar 

  19. Campos JH, Massa FC (1998) Is there a better right-sided tube for one-lung ventilation? A comparison of the right-sided double-lumen tube with the single-lumen tube with right-sided enclosed bronchial blocker. Anesth Analg 86:696–700

    Article  PubMed  CAS  Google Scholar 

  20. Ku CM, Slinger P, Waddell TK (2009) A novel method of treating hypoxemia during one-lung ventilation for thoracoscopic surgery. J Cardiothorac Vasc Anesth 23:850–852

    Article  PubMed  Google Scholar 

  21. Tobias JD (2001) Variations on one-lung ventilation. J Clin Anesth 13:35–39

    Article  PubMed  CAS  Google Scholar 

  22. Slinger P (2003) A view of and through double-lumen tubes. J Cardiothorac Vasc Anesth 17:287–288

    Article  PubMed  Google Scholar 

  23. Eberle B, Weiler N, Vogel N, Kauczor HU, Heinrichs W (1999) Computed tomography-based tracheobronchial image reconstruction allows selection of the individually appropriate double-lumen tube size. J Cardiothorac Vasc Anesth 13:532–537

    Article  PubMed  CAS  Google Scholar 

  24. Sustić A, Miletić D, Protić A, Ivancić A, Cicvarić T (2008) Can ultrasound be useful for predicting the size of a left double-lumen bronchial tube? Tracheal width as measured by ultrasonography versus computed tomography. J Clin Anesth 20:247–252

    Article  PubMed  Google Scholar 

  25. Hannallah MS, Benumof JL, Ruttimann UE (1995) The relationship between left mainstem bronchial diameter and patient size. J Cardiothorac Vasc Anesth 9:119–121

    Article  PubMed  CAS  Google Scholar 

  26. Brodsky JB, Lemmens HJ (2005) Tracheal width and left double-lumen tube size: a formula to estimate left-bronchial width. J Clin Anesth 17:267–270

    Article  PubMed  Google Scholar 

  27. Brodsky JB, Macario A, Mark JB (1996) Tracheal diameter predicts double-lumen tube size: a method for selecting left double-lumen tubes. Anesth Analg 82:861–864

    PubMed  CAS  Google Scholar 

  28. Brodsky JB, Malott K, Angst M, Fitzmaurice BG, Kee SP, Logan L (2001) The relationship between tracheal width and left bronchial width: implications for left-sided double-lumen tube selection. J Cardiothorac Vasc Anesth 15:216–217

    Article  PubMed  CAS  Google Scholar 

  29. Brodsky JB (2004) Fiberoptic bronchoscopy need not be a routine part of double-lumen tube placement. Curr Opin Anaesthesiol 17:7–11

    Article  PubMed  Google Scholar 

  30. Takita K, Morimoto Y, Kemmotsu O (2003) The height-based formula for prediction of left-sided double-lumen tracheal tube depth. J Cardiothorac Vasc Anesth 17:412–413

    Article  PubMed  Google Scholar 

  31. Hannallah M, Benumof JL, Silverman PM, Kelly LC, Lea D (1997) Evaluation of an approach to choosing a left double-lumen tube size based on chest computed tomographic scan measurement of left mainstem bronchial diameter. J Cardiothorac Vasc Anesth 11:168–171

    Article  PubMed  CAS  Google Scholar 

  32. Brodsky JB, Shulman MS, Mark JB (1985) Malposition of left-sided double-lumen endobronchial tubes. Anesthesiology 62:667–669

    Article  PubMed  CAS  Google Scholar 

  33. Lohser J, Brodsky JB (2005) Tracheal perforation from double-lumen tubes: size may be important. Anesth Analg 101:1243–1244 (author reply 4–5)

    Article  PubMed  Google Scholar 

  34. Sakuragi T, Kumano K, Yasumoto M, Dan K (1997) Rupture of the left main-stem bronchus by the tracheal portion of a double-lumen endobronchial tube. Acta Anaesthesiol Scand 41:1218–1220

    Article  PubMed  CAS  Google Scholar 

  35. Liu H, Jahr JS, Sullivan E, Waters PF (2004) Tracheobronchial rupture after double-lumen endotracheal intubation. J Cardiothorac Vasc Anesth 18:228–233

    Article  PubMed  Google Scholar 

  36. Clayton-Smith A, Bennett K, Alston RP et al (2015) 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 29:955–966

    Article  PubMed  Google Scholar 

  37. Hirsch NP, Smith GB (1985) Malposition of left-sided double-lumen endobronchial tubes. Anesthesiology 63:563

    Article  PubMed  CAS  Google Scholar 

  38. Striebel HW (2010) Die Anästhesie. Schattauer, Stuttgart

    Google Scholar 

  39. Seo JH, Kwon TK, Jeon Y, Hong DM, Kim HJ, Bahk JH (2013) Comparison of techniques for double-lumen endobronchial intubation: 90° or 180° rotation during advancement through the glottis. Br J Anaesth 111:812–817

    Article  PubMed  Google Scholar 

  40. Seegobin RD, van Hasselt GL (1984) Endotracheal cuff pressure and tracheal mucosal blood flow: endoscopic study of effects of four large volume cuffs. Br Med J (clin Res Ed) 288:965–968

    Article  CAS  Google Scholar 

  41. Touat L, Fournier C, Ramon P, Salleron J, Durocher A, Nseir S (2013) Intubation-related tracheal ischemic lesions: incidence, risk factors, and outcome. Intensive Care Med 39:575–582

    Article  PubMed  CAS  Google Scholar 

  42. Dincq AS, Lessire S, Mayné A, Putz L (2015) Double-lumen tubes for tracheostomized patients. J Cardiothorac Vasc Anesth 29:e35–e36

    Article  PubMed  Google Scholar 

  43. Teleflex (Hrsg) (2011) AIRWAYS – Die Kunst der Beatmung über die natürlichen Atemwege (Product overview)

    Google Scholar 

  44. Thomas V, Neustein SM (2007) Tracheal laceration after the use of an airway exchange catheter for double-lumen tube placement. J Cardiothorac Vasc Anesth 21:718–719

    Article  PubMed  Google Scholar 

  45. Campos JH (2007) Which device should be considered the best for lung isolation: double-lumen endotracheal tube versus bronchial blockers. Curr Opin Anaesthesiol 20:27–31

    Article  PubMed  Google Scholar 

  46. Hammer GB, Fitzmaurice BG, Brodsky JB (1999) Methods for single-lung ventilation in pediatric patients. Anesth Analg 89:1426–1429

    PubMed  CAS  Google Scholar 

  47. Di Nardo M, Perrotta D, Stoppa F, Cecchetti C, Marano M, Pirozzi N (2008) Independent lung ventilation in a newborn with asymmetric acute lung injury due to respiratory syncytial virus: a case report. J Med Case Rep 2:212

    Article  PubMed  PubMed Central  Google Scholar 

  48. Fitzmaurice BG, Brodsky JB (1999) Airway rupture from double-lumen tubes. J Cardiothorac Vasc Anesth 13:322–329

    Article  PubMed  CAS  Google Scholar 

  49. Schottke-Hennings H, Klippe HJ, Schmieding B (1989) Fiber bronchoscopy as an aid in placing and monitoring double lumen tubes in thoracic anesthesia. Anasth Intensivther Notfallmed 24:327–333

    Article  PubMed  CAS  Google Scholar 

  50. Narayanaswamy M, McRae K, Slinger P et al (2009) Choosing a lung isolation device for thoracic surgery: a randomized trial of three bronchial blockers versus double-lumen tubes. Anesth Analg 108:1097–1101

    Article  PubMed  CAS  Google Scholar 

  51. Cohen E (2002) Methods of lung separation. Curr Opin Anaesthesiol 15:69–78

    Article  PubMed  Google Scholar 

  52. Campos JH, Kernstine KH (2003) A comparison of a left-sided broncho-cath with the torque control blocker univent and the wire-guided blocker. Anesth Analg 96:283–289

    Article  PubMed  Google Scholar 

  53. Arndt GA, Kranner PW, Valdes-Mura H (2001) Reversal of hypoxemia using insufflation of oxygen during one-lung ventilation with a wire-guided endobronchial blocker. J Cardiothorac Vasc Anesth 15:144

    Article  PubMed  CAS  Google Scholar 

  54. Kus A, Hosten T, Gurkan Y, Gul Akgul A, Solak M, Toker K (2014) A comparison of the EZ-blocker with a Cohen flex-tip blocker for one-lung ventilation. J Cardiothorac Vasc Anesth 28:896–899

    Article  PubMed  Google Scholar 

  55. Campos JH (2010) Lung isolation techniques for patients with difficult airway. Curr Opin Anaesthesiol 23:12–17

    Article  PubMed  Google Scholar 

  56. Stephenson LL, Seefelder C (2011) Routine extraluminal use of the 5 F Arndt endobronchial blocker for one-lung ventilation in children up to 24 months of age. J Cardiothorac Vasc Anesth 25:683–686

    Article  PubMed  Google Scholar 

  57. Piccioni F, Vecchi I, Spinelli E, Previtali P, Langer M (2015) Extraluminal EZ-blocker placement for one-lung ventilation in pediatric thoracic surgery. J Cardiothorac Vasc Anesth 29:e71–e73

    Article  PubMed  Google Scholar 

  58. Merli G, Guarino A, Della Rocca G et al (2009) Recommendations for airway control and difficult airway management in thoracic anesthesia and lung separation procedures. Minerva Anestesiol 75(59–78):9–96

    Google Scholar 

  59. Tsuchihashi T, Ide S, Nakagawa H, Hishinuma N, Takano T, Nishizawa M (2007) Differential lung ventilation using laryngeal mask airway and a bronchial blocker tube for a patient with unanticipated difficult intubation. Masui 56:1075–1077

    PubMed  Google Scholar 

  60. Robinson AR, Gravenstein N, Alomar-Melero E, Peng YG (2008) Lung isolation using a laryngeal mask airway and a bronchial blocker in a patient with a recent tracheostomy. J Cardiothorac Vasc Anesth 22:883–886

    Article  PubMed  Google Scholar 

  61. Sawasdiwipachai P, Boonsri S, Suksompong S, Prowpan P (2015) The uses of laryngeal mask airway ProSeal™ and endobronchial blocker for one lung anesthesia. J Anesth 29:660–665

    Article  PubMed  Google Scholar 

  62. Cook Medical (Hrsg) (2014) Block with simplicity. Direct with ease (Product overview)

    Google Scholar 

  63. Cook Medical (Hrsg) (2015) Products that support you from the bedside to the procedure room

    Google Scholar 

  64. Teleflex (Hrsg) (2013) Rüsch EZ-blocker – endobronchial blocker product use guide (Product overview)

    Google Scholar 

  65. Medical C. ESC-D19804-EN, 05/2015.

  66. Campos JH (2003) An update on bronchial blockers during lung separation techniques in adults. Anesth Analg 97:1266–1274

    Article  PubMed  Google Scholar 

  67. Roscoe A, Kanellakos GW, McRae K, Slinger P (2007) Pressures exerted by endobronchial devices. Anesth Analg 104:655–658

    Article  PubMed  Google Scholar 

  68. Arndt GA, DeLessio ST, Kranner PW, Orzepowski W, Ceranski B, Valtysson B (1999) One-lung ventilation when intubation is difficult – presentation of a new endobronchial blocker. Acta Anaesthesiol Scand 43:356–358

    Article  PubMed  CAS  Google Scholar 

  69. Cohen E (2005) The Cohen flexitip endobronchial blocker: an alternative to a double lumen tube. Anesth Analg 101:1877–1879

    Article  PubMed  CAS  Google Scholar 

  70. Mourisse J, Liesveld J, Verhagen A et al (2013) Efficiency, efficacy, and safety of EZ-blocker compared with left-sided double-lumen tube for one-lung ventilation. Anesthesiology 118:550–561

    Article  PubMed  CAS  Google Scholar 

  71. Cohn S, Brodsky JB, Berry MF (2017) The EZ-blocker(®) in patients with short tracheas. J Cardiothorac Vasc Anesth. https://doi.org/10.1053/j.jvca.2016.04.029

    Article  PubMed  Google Scholar 

  72. Ueshima H, Otake H (2016) Bilateral pneumonectomy with difficult airway managed by using a combination of i‑gel and EZ-blocker. J Clin Anesth 34:516

    Article  PubMed  Google Scholar 

  73. Liu Z, He W, Jia Q, Yang X, Liang S, Wang X (2017) A comparison of extraluminal and intraluminal use of the Uniblocker in left thoracic surgery: A CONSORT-compliant article. Medicine (Baltimore) 96:e6966

    Article  Google Scholar 

  74. Gayes JM (1993) Pro: one-lung ventilation is best accomplished with the univent endotracheal tube. J Cardiothorac Vasc Anesth 7:103–107

    Article  PubMed  CAS  Google Scholar 

  75. Campos JH, Reasoner DK, Moyers JR (1996) Comparison of a modified double-lumen endotracheal tube with a single-lumen tube with enclosed bronchial blocker. Anesth Analg 83:1268–1272

    Article  PubMed  CAS  Google Scholar 

  76. Heir JS, Purugganan R, Jackson TA et al (2014) A retrospective evaluation of the use of video-capable double-lumen endotracheal tubes in thoracic surgery. J Cardiothorac Vasc Anesth 28:870–872

    Article  PubMed  Google Scholar 

  77. Levy-Faber D, Malyanker Y, Nir RR, Best LA, Barak M (2015) Comparison of VivaSight double-lumen tube with a conventional double-lumen tube in adult patients undergoing video-assisted thoracoscopic surgery. Anaesthesia 70:1259–1263

    Article  PubMed  CAS  Google Scholar 

  78. Schuepbach R, Grande B, Camen G et al (2015) Intubation with VivaSight or conventional left-sided double-lumen tubes: a randomized trial. Can J Anaesth 62:762–769

    Article  PubMed  Google Scholar 

  79. Koopman EM, Barak M, Weber E et al (2015) Evaluation of a new double-lumen endobronchial tube with an integrated camera (VivaSight-DL(™)): a prospective multicentre observational study. Anaesthesia 70:962–968

    Article  PubMed  CAS  Google Scholar 

  80. Heir JS, Guo SL, Purugganan R et al (2018) A randomized controlled study of the use of video double-lumen endobronchial tubes versus double-lumen endobronchial tubes in thoracic surgery. J Cardiothorac Vasc Anesth 32(1):267–274. https://doi.org/10.1053/j.jvca.2017.05.016

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. FB Medizin, Klinik für Anästhesie und Intensivtherapie, Universitätsklinikum Gießen und Marburg, Standort Marburg, Philipps Universität Marburg, Baldingerstraße, 35032, Marburg, Deutschland

    K. M. Meggiolaro,  H. Wulf,  C. Feldmann,  T. Wiesmann,  A.-K. Schubert &  J. Risse

Authors
  1. K. M. Meggiolaro
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. Wulf
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Feldmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. T. Wiesmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A.-K. Schubert
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. Risse
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to K. M. Meggiolaro.

Ethics declarations

Interessenkonflikt

K.M. Meggiolaro und J. Risse erhielten für eine klinische Studie eine materielle Unterstützung von Verathon. H. Wulf bekam Beraterhonorare von der Fa. B. Braun, Sintetica, Vortragshonorare von MSD, Grünenthal, Edwards und Forschungsunterstützung von Teleflex. T. Wiesmann wurde honoriert für Beratertätigkeit für B. Braun, Melsungen, Deutschland. C. Feldmann und A.-K. Schubert geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Meggiolaro, K.M., Wulf, H., Feldmann, C. et al. Atemwegsmanagement zur Seitentrennung der Lunge bei thorakalen Eingriffen. Anaesthesist 67, 555–567 (2018). https://doi.org/10.1007/s00101-018-0470-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00101-018-0470-1

Schlüsselwörter

Keywords

Search

Navigation