Skip to main content
SpringerLink
Log in

Lung Isolation

  • Chapter
  • First Online:
Book cover Principles and Practice of Anesthesia for Thoracic Surgery

Abstract

During the preoperative period, review of the posterior–anterior chest radiograph is necessary to measure the tracheal width and also appreciate the pattern of the tracheobronchial anatomy to determine what device and size to use. The left-sided DLT is the most common device used for lung isolation because of its greater margin of safety. The use of bronchial blockers is indicated in patients who present with difficult airways and require lung isolation. Patients with a tracheostomy in place requiring lung isolation are best managed with the use of an independent bronchial blocker and flexible fiberoptic bronchoscopy. Flexible fiberoptic bronchoscopy is the recommended method to achieve optimal position of lung isolation devices, first in supine position, later in lateral decubitus, or whenever a malposition occurs.

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

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Campos JH. Current techniques for perioperative lung isolation in adults. Anesthesiology. 2002;97:1295–301.

    Article  PubMed  Google Scholar 

  2. Campos JH. Progress in lung separation. Thorac Surg Clin. 2005;15:71–83.

    Article  PubMed  Google Scholar 

  3. Lewis Jr JW, Serwin JP, Gabriel FS, Bastanfar M, Jacobsen G. The utility of a double-lumen tube for one-lung ventilation in a variety of noncardiac thoracic surgical procedures. J Cardiothorac Vasc Anesth. 1992;6:705–10.

    Article  PubMed  Google Scholar 

  4. Campos JH. An update on bronchial blockers during lung separation techniques in adults. Anesth Analg. 2003;97:1266–74.

    Article  PubMed  Google Scholar 

  5. Campos JH, Kernstine KH. A comparison of a left-sided Broncho-Cath with the torque control blocker univent and the wire-guided blocker. Anesth Analg. 2003;96:283–9.

    PubMed  Google Scholar 

  6. Arndt GA, Kranner PW, Rusy DA, Love R. Single-lung ventilation in a critically ill patient using a fiberoptically directed wire-guided endobronchial blocker. Anesthesiology. 1999;90:1484–6.

    Article  PubMed  CAS  Google Scholar 

  7. Cohen E. The Cohen flexitip endobronchial blocker: an alternative to a double lumen tube. Anesth Analg. 2005;101:1877–9.

    Article  PubMed  CAS  Google Scholar 

  8. Narayanaswamy M, McRae K, Slinger P, et al. Choosing a lung isolation device for thoracic surgery: a randomized trial of three bronchial blockers versus double-lumen tubes. Anesth Analg. 2009;108:1097–101.

    Article  PubMed  CAS  Google Scholar 

  9. Bjork VO, Carlens E. The prevention of spread during pulmonary resection by the use of a double-lumen catheter. J Thorac Surg. 1950;20:151–7.

    PubMed  CAS  Google Scholar 

  10. Campos JH, Massa FC, Kernstine KH. The incidence of right upper-lobe collapse when comparing a right-sided double-lumen tube versus a modified left double-lumen tube for left-sided thoracic surgery. Anesth Analg. 2000;90:535–40.

    Article  PubMed  CAS  Google Scholar 

  11. Seymour AH, Prakash N. A cadaver study to measure the adult glottis and subglottis: defining a problem associated with the use of double-lumen tubes. J Cardiothorac Vasc Anesth. 2002;16:196–8.

    Article  PubMed  Google Scholar 

  12. Sivalingam P, Tio R. Tension pneumothorax, pneumomediastinum, pneumoperitoneum, and subcutaneous emphysema in a 15-year-old Chinese girl after a double-lumen tube intubation and one-lung ventilation. J Cardiothorac Vasc Anesth. 1999;13:312–5.

    Article  PubMed  CAS  Google Scholar 

  13. Bardoczky G, d’Hollander A, Yernault JC, et al. On-line expiratory flow-volume curves during thoracic surgery: occurrence of auto-PEEP. Br J Anaesth. 1994;72:25–8.

    Article  PubMed  CAS  Google Scholar 

  14. Sakuragi T, Kumano K, Yasumoto M, Dan K. Rupture of the left main-stem bronchus by the tracheal portion of a double-lumen endobronchial tube. Acta Anaesthesiol Scand. 1997;41:1218–20.

    Article  PubMed  CAS  Google Scholar 

  15. Hannallah M, Gomes M. Bronchial rupture associated with the use of a double-lumen tube in a small adult. Anesthesiology. 1989;71:457–8.

    Article  PubMed  CAS  Google Scholar 

  16. Brodsky JB, Macario A, Mark JB. Tracheal diameter predicts double-lumen tube size: a method for selecting left double-lumen tubes. Anesth Analg. 1996;82:861–4.

    PubMed  CAS  Google Scholar 

  17. Chow MY, Liam BL, Lew TW, Chelliah RY, Ong BC. Predicting the size of a double-lumen endobronchial tube based on tracheal diameter. Anesth Analg. 1998;87:158–60.

    PubMed  CAS  Google Scholar 

  18. Amar D, Desiderio DP, Heerdt PM, et al. Practice patterns in choice of left double-lumen tube size for thoracic surgery. Anesth Analg. 2008;106:379–83.

    Article  PubMed  Google Scholar 

  19. Eberle B, Weiler N, Vogel N, Kauczor HU, Heinrichs W. Computed tomography-based tracheobronchial image reconstruction allows selection of the individually appropriate double-lumen tube size. J Cardiothorac Vasc Anesth. 1999;13:532–7.

    Article  PubMed  CAS  Google Scholar 

  20. Brodsky JB, Benumof JL, Ehrenwerth J, Ozaki GT. Depth of placement of left double-lumen endobronchial tubes. Anesth Analg. 1991;73:570–2.

    Article  PubMed  CAS  Google Scholar 

  21. Boucek CD, Landreneau R, Freeman JA, Strollo D, Bircher NG. A comparison of techniques for placement of double-lumen endobronchial tubes. J Clin Anesth. 1998;10:557–60.

    Article  PubMed  CAS  Google Scholar 

  22. Brodsky JB, Lemmens HJ. Left double-lumen tubes: clinical experience with 1,170 patients. J Cardiothorac Vasc Anesth. 2003;17:289–98.

    Article  PubMed  Google Scholar 

  23. Benumof JL, Partridge BL, Salvatierra C, Keating J. Margin of safety in positioning modern double-lumen endotracheal tubes. Anesthesiology. 1987;67:729–38.

    Article  PubMed  CAS  Google Scholar 

  24. McKenna MJ, Wilson RS, Botelho RJ. Right upper lobe obstruction with right-sided double-lumen endobronchial tubes: a comparison of two tube types. J Cardiothorac Anesth. 1988;2:734–40.

    Article  PubMed  CAS  Google Scholar 

  25. Campos JH, Gomez MN. Pro: right-sided double-lumen endotracheal tubes should be routinely used in thoracic surgery. J Cardiothorac Vasc Anesth. 2002;16:246–8.

    Article  PubMed  Google Scholar 

  26. Bussières JS, Lacasse Y, Côté D, et al. Modified right-sided Broncho-Cath® double lumen tube improves endobronchial positioning: a randomized study. Can J Anaesth. 2007;54:276–82.

    Article  PubMed  Google Scholar 

  27. Stene R, Rose M, Weinger MB, Benumof JL, Harrell J. ­Bronchial trifurcation at the carina complicating use of a double-lumen ­tracheal tube. Anesthesiology. 1994;80:1162–3.

    Article  PubMed  CAS  Google Scholar 

  28. Ehrenfeld JM, Walsh JL, Sandberg WS. Right- and left-sided Mallinckrodt double-lumen tubes have identical clinical performance. Anesth Analg. 2008;106:1847–52.

    Article  PubMed  Google Scholar 

  29. Campos JH. Update on tracheobronchial anatomy and flexible fiberoptic bronchoscopy in thoracic anesthesia. Curr Opin Anaesthesiol. 2009;22:4–10.

    Article  PubMed  Google Scholar 

  30. Klein U, Karzai W, Bloos F, et al. Role of fiberoptic bronchoscopy in conjunction with the use of double-lumen tubes for thoracic anesthesia: a prospective study. Anesthesiology. 1998;88:346–50.

    Article  PubMed  CAS  Google Scholar 

  31. Sherry K. Management of patients undergoing oesophagectomy. In: Gray AJG, Hoile RW, Ingram GS, Sherry K, editors. The Report of the National Confidential Enquiry into Perioperative Deaths 1996/1997. NCEPOD: London; 1998. p. 57–61.

    Google Scholar 

  32. Pennefather SH, Russell GN. Placement of double lumen tubes – time to shed light on an old problem. Br J Anaesth. 2000;84:308–10.

    PubMed  CAS  Google Scholar 

  33. Seymour AH, Prasad B, McKenzie RJ. Audit of double-lumen endobronchial intubation. Br J Anaesth. 2004;93:525–7.

    Article  PubMed  CAS  Google Scholar 

  34. Slinger P. A view of and through double-lumen tubes. J Cardiothorac Vasc Anesth. 2003;17:287–8.

    Article  PubMed  Google Scholar 

  35. Campos JH, Hallam EA, Van Natta T, Kernstine KH. Devices for lung isolation used by anesthesiologists with limited thoracic experience: comparison of double-lumen endotracheal tube, Univent torque control blocker, and Arndt wire-guided endobronchial blocker. Anesthesiology. 2006;104:261–6.

    Article  PubMed  Google Scholar 

  36. Lohser J, Brodsky JB. Silbronco double-lumen tube. J Cardiothorac Vasc Anesth. 2006;20:129–31.

    Article  PubMed  Google Scholar 

  37. Hagihira S, Takashina M, Mashimo T. Application of a newly designed right-sided, double-lumen endobronchial tube in patients with a very short right mainstem bronchus. Anesthesiology. 2008;109:565–8.

    Article  PubMed  Google Scholar 

  38. Ghosh S, Falter F, Goldsmith K, Arrowsmith JE. The Papworth BiVent tube: a new device for lung isolation. Anaesthesia. 2008;63:996–1000.

    Article  PubMed  CAS  Google Scholar 

  39. Ghosh S, Klein AA, Prabhu M, Falter F, et al. The Papworth BiVent tube: a feasibility study of a novel double-lumen endotracheal tube and bronchial blocker in human cadavers. Br J Anaesth. 2008;101:424–8.

    Article  PubMed  CAS  Google Scholar 

  40. Saito S, Dohi S, Naito H. Alteration of double-lumen endobronchial tube position by flexion and extension of the neck. Anesthesiology. 1985;62:696–7.

    Article  PubMed  CAS  Google Scholar 

  41. Yüceyar L, Kaynak K, Cantürk E, Aykaç B. Bronchial rupture with a left-sided polyvinylchloride double-lumen tube. Acta Anaesthesiol Scand. 2003;47:622–5.

    Article  PubMed  Google Scholar 

  42. Liu H, Jahr JS, Sullivan E, Waters PF. Tracheobronchial rupture after double-lumen endotracheal intubation. J Cardiothorac Vasc Anesth. 2004;18:228–33.

    Article  PubMed  Google Scholar 

  43. Benumof JL, Wu D. Tracheal tear caused by extubation of a double-lumen tube. Anesthesiology. 2002;97:1007–8.

    Article  PubMed  Google Scholar 

  44. Sucato DJ, Girgis M. Bilateral pneumothoraces, pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum, and subcutaneous emphysema following intubation with a double-lumen endotracheal tube for thoracoscopic anterior spinal release and fusion in a patient with idiopathic scoliosis. J Spinal Disord Tech. 2002;15:133–8.

    Article  PubMed  Google Scholar 

  45. Weng W, DeCrosta DJ, Zhang H. Tension pneumothorax during one-lung ventilation: a case report. J Clin Anesth. 2002;14:529–31.

    Article  PubMed  Google Scholar 

  46. Fitzmaurice BG, Brodsky JB. Airway rupture from double-lumen tubes. J Cardiothorac Vasc Anesth. 1999;13:322–9.

    Article  PubMed  CAS  Google Scholar 

  47. Knoll H, Ziegeler S, Schreiber JU, et al. Airway injuries after one-lung ventilation: a comparison between double-lumen tube and endobronchial blocker: a randomized, prospective, controlled trial. Anesthesiology. 2006;105:471–7.

    Article  PubMed  Google Scholar 

  48. Campos JH. Effects of oxygenation during selective lobar versus total lung collapse with or without continuous positive airway pressure. Anesth Analg. 1997;85:583–6.

    PubMed  CAS  Google Scholar 

  49. Campos JH, Ledet C, Moyers JR. Improvement of arterial oxygen saturation with selective lobar bronchial block during hemorrhage in a patient with previous contralateral lobectomy. Anesth Analg. 1995;81:1095–6.

    PubMed  CAS  Google Scholar 

  50. Amar D, Desiderio DP, Bains MS, Wilson RS. A novel method of one-lung isolation using a double endobronchial blocker technique. Anesthesiology. 2001;95:1528–30.

    Article  PubMed  CAS  Google Scholar 

  51. Espí C, García-Guasch R, Ibáñez C, Fernández E, Astudillo J. Selective lobar blockade using an Arndt endobronchial blocker in 2 patients with respiratory compromise who underwent lung resection. Arch Bronconeumol. 2007;43:346–8.

    Article  PubMed  Google Scholar 

  52. Ng JM, Hartigan PM. Selective lobar bronchial blockade following contralateral pneumonectomy. Anesthesiology. 2003;98:268–70.

    Article  PubMed  Google Scholar 

  53. Hagihira S, Maki N, Kawaguchi M, Slinger P. Selective bronchial blockade in patients with previous contralateral lung surgery. J Cardiothorac Vasc Anesth. 2002;16:638–42.

    Article  PubMed  Google Scholar 

  54. Campos JH. Update on selective lobar blockade during pulmonary resections. Curr Opin Anaesthesiol. 2009;22:18–22.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  56. Hagihira S, Takashina M, Mori T, Yoshiya I. One-lung ventilation in patients with difficult airways. J Cardiothorac Vasc Anesth. 1998;12:186–8.

    Article  PubMed  CAS  Google Scholar 

  57. Baraka A. The univent tube can facilitate difficult intubation in a patient undergoing thoracoscopy. J Cardiothorac Vasc Anesth. 1996;10:693–4.

    Article  PubMed  CAS  Google Scholar 

  58. Ransom ES, Carter SL, Mund GD. Univent tube: a useful device in patients with difficult airways. J Cardiothorac Vasc Anesth. 1995;9:725–7.

    Article  PubMed  CAS  Google Scholar 

  59. Campos JH. Difficult airway and one-lung ventilation. Curr Rev Clin Anesth. 2002;22:197–208.

    Google Scholar 

  60. García-Aguado R, Mateo EM, Tommasi-Rosso M, et al. Thoracic surgery and difficult intubation: another application of univent tube for one-lung ventilation. J Cardiothorac Vasc Anesth. 1997;11:925–6.

    Article  PubMed  Google Scholar 

  61. García-Aguado R, Mateo EM, Onrubia VJ, Bolinches R. Use of the Univent System tube for difficult intubation and for achieving one-lung anaesthesia. Acta Anaesthesiol Scand. 1996;40:765–7.

    Article  PubMed  Google Scholar 

  62. Takenaka I, Aoyama K, Kadoya T. Use of the univent bronchial-blocker tube for unanticipated difficult endotracheal intubation. Anesthesiology. 2000;93:590–1.

    Article  PubMed  CAS  Google Scholar 

  63. Campos JH. How to achieve successful lung separation. SAJAA. 2008;14:22–6.

    Google Scholar 

  64. Arndt GA, DeLessio ST, Kranner PW, et al. One-lung ventilation when intubation is difficult-presentation of a new endobronchial blocker. Acta Anaesthesiol Scand. 1999;43:356–8.

    Article  PubMed  CAS  Google Scholar 

  65. Arndt GA, Buchika S, Kranner PW, DeLessio ST. Wire-guided endobronchial blockade in a patient with a limited mouth opening. Can J Anaesth. 1999;46:87–9.

    Article  PubMed  CAS  Google Scholar 

  66. Grocott HP, Scales G, Schinderle D, King K. A new technique for lung isolation in acute thoracic trauma. J Trauma. 2000;49:940–2.

    Article  PubMed  CAS  Google Scholar 

  67. Byhahn C, Habler OP, Bingold TM, et al. The wire-guided endobronchial blocker: applications in trauma patients beyond mere single-lung ventilation. J Trauma. 2006;61:755–9.

    Article  PubMed  Google Scholar 

  68. Campos JH, Kernstine KH. Use of the wire-guided endobronchial blocker for one-lung anesthesia in patients with airway abnormalities. J Cardiothorac Vasc Anesth. 2003;17:352–4.

    Article  PubMed  Google Scholar 

  69. Kabon B, Waltl B, Leitgeb J, Kapral S, Zimpfer M. First experience with fiberoptically directed wire-guided endobronchial blockade in severe pulmonary bleeding in an emergency setting. Chest. 2001;120:1399–402.

    Article  PubMed  CAS  Google Scholar 

  70. Kazari W. Alternative method to deflate the operated lung when using wire-guided endobronchial blockade. Anesthesiology. 2003;99:239–40.

    Google Scholar 

  71. Campos JH. In response: an Alternative method to deflate the operated lung when using wire guided endobronchial blockade. Anesthesiology. 2003;99:241.

    Article  Google Scholar 

  72. Soto RG, Oleszak SP. Resection of the Arndt bronchial blocker during stapler resection of the left lower lobe. J Cardiothorac Vasc Anesth. 2006;20:131–2.

    Article  PubMed  Google Scholar 

  73. Roscoe A, Kanellakos GW, McRae K, Slinger P. Pressures exerted by endobronchial devices. Anesth Analg. 2007;104:655–8.

    Article  PubMed  Google Scholar 

  74. Lizuka T, Tanno M, Hamada Y, Shga T, Ohe Y. Uniblocker® bronchial blocker tube to facilitate one-lung ventilation during thoracoscopic surgery. Anesthesiology. 2007;108:A1815.

    Google Scholar 

  75. Campos JH, Kernstine KH. A structural complication in the torque control blocker Univent: fracture of the blocker cap connector. Anesth Analg. 2003;96:630–1.

    PubMed  Google Scholar 

  76. Peragallo RA, Swenson JD. Congenital tracheal bronchus: the inability to isolate the right lung with a univent bronchial blocker tube. Anesth Analg. 2000;91:300–1.

    PubMed  CAS  Google Scholar 

  77. Asai T. Failure of the Univent bronchial blocker in sealing the bronchus. Anaesthesia. 1999;54:97.

    Article  PubMed  CAS  Google Scholar 

  78. Thielmeier KA, Anwar M. Complication of the Univent tube. Anesthesiology. 1996;84:491.

    Article  PubMed  CAS  Google Scholar 

  79. Dougherty P, Hannallah M. A potentially serious complication that resulted from improper use of the Univent tube. Anesthesiology. 1992;77:835.

    Article  PubMed  CAS  Google Scholar 

  80. Prabhu MR, Smith JH. Use of the Arndt wire-guided endobronchial blocker. Anesthesiology. 2002;97:1325.

    Article  PubMed  Google Scholar 

  81. Sandberg WS. Endobronchial blocker dislodgement leading to pulseless electrical activity. Anesth Analg. 2005;100:1728–30.

    Article  PubMed  Google Scholar 

  82. Brodsky JB, Tobler HG, Mark JB. A double-lumen endobronchial tube for tracheostomies. Anesthesiology. 1991;74:387–8.

    Article  PubMed  CAS  Google Scholar 

  83. Saito T, Naruke T, Carney E, et al. New double intrabronchial tube (Naruke tube) for tracheostomized patients. Anesthesiology. 1998;89:1038–9.

    Article  PubMed  CAS  Google Scholar 

  84. Bellver J, García-Aguado R, De Andrés J, Valía JC, Bolinches R. Selective bronchial intubation with the univent system in patients with a tracheostomy. Anesthesiology. 1993;79:1453–4.

    Article  PubMed  CAS  Google Scholar 

  85. Dhamee MS. One-lung ventilation in a patient with a fresh tracheostomy using the tracheostomy tube and a Univent endobronchial blocker. J Cardiothorac Vasc Anesth. 1997;11:124–5.

    Article  PubMed  CAS  Google Scholar 

  86. Tobias JD. Variations on one-lung ventilation. J Clin Anesth. 2001;13:35–9.

    Article  PubMed  CAS  Google Scholar 

  87. Ko R, McRae K, Darling G, et al. The use of air in the inspired gas mixture during two-lung ventilation delays lung collapse during one-lung ventilation. Anesth Analg. 2009;108:1092–6.

    Article  PubMed  Google Scholar 

  88. Hesselfeldt R, Kristensen MS, Rasmussen LS, et al. Evaluation of the airway of the SimMan® full-scale patient simulator. Acta Anaesthesiol Scand. 2005;49:1339–45.

    Article  PubMed  CAS  Google Scholar 

  89. Wong AK. Full scale computer simulators in anesthesia training and evaluation. Can J Anaesth. 2004;51:455–64.

    Article  PubMed  Google Scholar 

  90. Nyssen AS, Larbuisson R, Janssens M, et al. A comparison of the training value of two types of anesthesia simulators: computer screen-based and mannequin-based simulators. Anesth Analg. 2002;94:1560–5.

    PubMed  Google Scholar 

  91. Duffy CH, Myles PS. Review: thoracic-anesthesia.com. J Cardiothorac Vasc Anesth. 2008;22:644.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesia, University of Iowa Health Care, Roy and Lucille Carver College of Medicine, Iowa City, IA, USA

    Javier Campos MD

Authors
  1. Javier Campos MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Javier Campos MD .

Editor information

Editors and Affiliations

  1. University of Toronto, Staff Anesthesiologist, Professor of Anesthesia, Toronto, M5G 2C4, Ontario, Canada

    Peter Slinger, MD, FRCPC

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Campos, J. (2011). Lung Isolation. In: Slinger, MD, FRCPC, P. (eds) Principles and Practice of Anesthesia for Thoracic Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-0184-2_16

Download citation

  • DOI: https://doi.org/10.1007/978-1-4419-0184-2_16

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4419-0183-5

  • Online ISBN: 978-1-4419-0184-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation