scholarly journals Incidental left main bronchus obstruction during left-sided double-lumen tube intubation of a patient with an unrecognized tracheal bronchus

Medicine ◽  
2016 ◽  
Vol 95 (52) ◽  
pp. e5674 ◽  
Author(s):  
Ho Bum Cho ◽  
Hyoung June Kim ◽  
Hyung Youn Gong ◽  
Mun Gyu Kim ◽  
Sang Ho Kim
2013 ◽  
Vol 2013 ◽  
pp. 1-3
Author(s):  
William R. Hartman ◽  
Michael Brown ◽  
James Hannon

Tracheobronchial disruption is an uncommon but severe complication of double lumen endotracheal tube placement. The physical properties of a double lumen tube (large external diameter and length) make tracheobronchial injury more common than that associated with smaller single lumen endotracheal tubes. Here we present the case of an iatrogenic left main bronchus injury caused by placement of a double lumen tube in an otherwise unremarkable airway.


2003 ◽  
Vol 31 (1) ◽  
pp. 50-53 ◽  
Author(s):  
W. J. Russell ◽  
T. S. Strong

The diameter of the left main bronchus is the determining dimension when selecting the size of a left tracheobronchial (double-lumen) tube for lung separation. However, this information is not given by any manufacturer, either on the tube or in the package insert. This paper describes the lengths and diameters of the deflated bronchial cuff segment of left tracheobronchial tubes in common use. One hundred and seventy-one left tracheobronchial tubes ranging in size from 28 to 41 nominal French gauge from four manufacturers were measured. There was wide variation between tubes of the same nominal size from the same manufacturer. For tubes of the same size from the same manufacturer, the diameter of the segment with the deflated bronchial cuff varied by more than 1 mm in diameter in some instances.The diameter of the bronchial cuff segment did not consistently decrease as the nominal size decreased even for the same manufacturer. There was major overlap in diameters of the bronchial segments between Fr 41, Fr 39, and Fr 37 tubes from most manufacturers, so that some of the Fr 39 tubes have a bronchial cuff segment diameter as much as 0.5 mm larger than the Fr 41 tube. It is concluded that the current French gauge markings on left tracheobronchial tubes are of very limited value in determining the appropriate size to be selected for a patient. More accurate and consistent dimensions of tracheobronchial tubes are required to improve clinical selection.


CHEST Journal ◽  
1983 ◽  
Vol 83 (6) ◽  
pp. 928-929 ◽  
Author(s):  
Nelson A Burton ◽  
Stephen M. Fall ◽  
Thomas Lyons ◽  
Geoffrey M. Graeber

2021 ◽  
Author(s):  
Wenzhu Wang ◽  
Ji Li ◽  
Jian Liu ◽  
Chengwei Song ◽  
ya-nan Zhang

Abstract Background: Intubation difficulties, hypoxemia, inability to perform a one-lung ventilation, and high airway pressure often occur during double-lumen tube intubation. Tracheal bronchus is a very rare and difficult to find reason. We present a case of tracheal bronchus accidentally discovered during double-lumen tube intubation in a patient undergoing thoracic surgery. We are the first one to summarize the one-lung ventilation strategy for patients with tracheal bronchus. Case Presentation: A 53-year-old man underwent a scheduled thoracoscopic left upper lobectomy. After two unsuccessful attempts to pass the right-sided double-lumen tube through the right mainstem bronchus, fiberoptic bronchoscopy revealed an aberrant tracheal bronchus with an incidence of 0.1%–3%. Finally we used a left-sided DLT to ventilate the right lung. The patient had no airway complications and was discharged 7 days after the operation.Conclusions: This case serves to remind us that preoperative visits must be thorough and careful. Although a computed tomography chest examination was performed before surgery, we just looked at the inspection report and did not look at the images. We also reviewed relevant literature and summarized the one-lung ventilation strategies for patients with tracheal bronchus. For left-lung ventilation, either a left-sided double-lumen tube or a combination of a bronchial blocker and Fogarty artery embolization catheter can be used. For right-lung ventilation, a bronchial blocker or a left-sided double-lumen tube is a good choice.


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