scholarly journals Difficult Management of a Double-Lumen Endotracheal Tube and Difficult Ventilation during Robotic Thymectomy with Carbon Dioxide Insufflation

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Yuki Sugiyama ◽  
Kunihiro Mitsuzawa ◽  
Yuki Yoshiyama ◽  
Fumiko Shimizu ◽  
Satoshi Fuseya ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Endotracheal Tube ◽  
Intraoperative Complications ◽  
Lung Ventilation ◽  
Double Lumen ◽  
Double Lumen Endotracheal Tube ◽  
Lung Expansion ◽  
Distal Migration ◽  
Difficult Ventilation ◽  
Robotic Thymectomy

Robotic surgery with carbon dioxide (CO2) insufflation to the thorax is frequently performed to gain a better operative field of view, although its intraoperative complications have not yet been discussed in detail. We treated two patients with difficult ventilation caused by distal migration of a double-lumen endotracheal tube (DLT) during robotic thymectomy. In the first case, migration of the DLT during one-lung ventilation (OLV) occurred after CO2 insufflation to the bilateral thoraxes was started. Oxygenation rapidly deteriorated because dependent lung expansion was restricted by CO2 insufflation. In the second case, migration of the DLT during OLV occurred while CO2 insufflation to a unilateral thorax and mediastinum was performed. In both cases, once migration of the DLT during OLV occurred with CO2 insufflation, readjusting the DLT became very difficult because our manipulation of bronchofiberscopy was prevented by the robot arms located above the patient’s head and because deformation of the trachea/bronchus induced by CO2 insufflation caused a poor image of the bronchofiberscopic view. Thus, during robotic-assisted thoracoscopic surgery with CO2 insufflation, since there is a potential risk of difficult ventilation with a DLT and since readjustment of the DLT is very difficult, discontinuing CO2 insufflation and switching to double-lung ventilation are needed in such a situation.

scholarly journals Independent Lung Ventilation-Experimental Studies on a 3D Printed Respiratory Tract Model

Materials ◽  
2021 ◽  
Vol 14 (18) ◽  
pp. 5189
Author(s):  
Katarzyna Kramek-Romanowska ◽  
Anna M. Stecka ◽  
Krzysztof Zieliński ◽  
Agata Dorosz ◽  
Piotr Okrzeja ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Flow Distribution ◽  
Lung Ventilation ◽  
Bronchial Tree ◽  
Double Lumen ◽  
Flow Measurements ◽  
Double Lumen Endotracheal Tube ◽  
3D Printed ◽  
Independent Lung Ventilation

Independent lung ventilation (ILV) is a life-saving procedure in unilateral pulmonary pathologies. ILV is underused in clinical practice, mostly due to the technically demanding placement of a double lumen endotracheal tube (ETT). Moreover, the determination of ventilation parameters for each lung in vivo is limited. In recent years, the development of 3D printing techniques enabled the production of highly accurate physical models of anatomical structures used for in vitro research, considering the high risk of in vivo studies. The purpose of this study was to assess the influence of double-lumen ETT on the gas transport and mixing in the anatomically accurate 3D-printed model of the bronchial tree, with lung lobes of different compliances, using various ventilation modes. The bronchial tree was obtained from Respiratory Drug Delivery (RDD Online, Richmond, VA, USA), processed and printed by a dual extruder FFF 3D printer. The test system was also composed of left side double-lumen endotracheal tube, Siemens Test Lung 190 and anesthetic breathing bag (as lobes). Pressure and flow measurements were taken at the outlets of the secondary bronchus. The measured resistance increased six times in the presence of double-lumen ETT. Differences between the flow distribution to the less and more compliant lobe were more significant for the airways with double-lumen ETT. The ability to predict the actual flow distribution in model airways is necessary to conduct effective ILV in clinical conditions.

scholarly journals A Comparative Study of the Efficacy of an Improved Double-Lumen Tube Ventilation Control Device Versus A Conventional Device in Thoracic Surgery: A Randomized Controlled Trial

2021 ◽  
Author(s):  
Chang Liu ◽  
Xin Wang ◽  
Yue Wang ◽  
Yuanyu Zhao ◽  
Huiwen Guan ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Lung Ventilation ◽  
Double Lumen Tube ◽  
Intubation Time ◽  
Tube Insertion ◽  
Double Lumen ◽  
Lumen Tube ◽  
Double Lumen Endotracheal Tube ◽  
Time Required ◽  
Gas Volume

Abstract Background: To improve the conversion efficiency between single-lung and double-lung ventilation after Double-lumen tube(DLT) intubation, we invented a Y-shaped rotatable adjustment between three-lumen tube and double-lumen tube connector (YRC). The performance of YRC was studied with the traditional Y-shaped reconnector (YC) as the control. Methods: A total of 60 adult patients who underwent thoracic surgery with double-lumen endotracheal tube insertion were included in the study. The subjects after endotracheal tube insertion were randomly divided into two groups: YRC connecting group (YRC group, n=30) and a traditional connector connecting group (YC group, n=30), respectively. Primary endpoints were intubation time and conversion time of single-lung ventilation to double-lung ventilation. The secondary endpoints of this study were the internal gas volume of the two joints, airway pressure, and the time required for sputum aspiration during the operation. Results: Intubation time in YRC group was shorter than that in YC group (89.75±14.28s vs 107.80±14.96s, p=0.00). Compared with the YC group, the time required for ventilation conversion between single-lung and double-lung ventilation during the operation in the YRC group were significantly shortened (3.60±1.20svs9.05±2.53s, p=0.00). The internal gas volume in YRC (17.20ml) is smaller than YC (24.12ml). There was no statistical difference in airway pressure and the time required for sputum aspiration between YRC group and YC group (P > 0.05). Conclusion: Compared with the traditional connectors, the YRC can improve the conversion efficiency between single-lung ventilation and double-lung ventilation with double-lumen endotracheal tube, save positioning time, and can be safely used for the anesthesia management of double-lumen endotracheal tube. Trial registration: This clinical research was registered at the Chinese Clinical Trial Registry(www.chictr.org.cn,ChiCTR2000040188).

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