Lung Isolation

2018 ◽  
Author(s):  
Bryan Hierlmeier ◽  
Vanetta Levesque ◽  
Henrique Vale
Keyword(s):  
Thoracoscopic Surgery ◽  
Hypoxic Pulmonary Vasoconstriction ◽  
Lung Ventilation ◽  
Double Lumen Tube ◽  
Lung Protective Ventilation ◽  
One Lung Ventilation ◽  
Double Lumen ◽  
Lung Isolation ◽  
Pulmonary Vasoconstriction ◽  
Protective Strategies

Lung isolation is being used more frequently in adult patients due to increasing incidence of thoracoscopy and video-assisted thoracoscopic surgery. There are several indications for lung isolation and one-lung ventilation (OLV) during surgery. Isolation is usually achieved by double-lumen endotracheal tubes or use of some type of bronchial blocker system. The initiation of OLV frequently leads to hypoxemia, the management of which should be stepwise. Additionally, clinical outcomes are significantly improved with the use of lung protective strategies during OLV. This review covers the use of few of the most common lung isolation devices, management of OLV using lung protective ventilation strategies, and management of oxygenation and hypoxemia during OLV. This review contains 12 figures, 6 tables, and 36 references. Key Words: bronchial blockers, double-lumen tube, uninvent, hypoxemia, hypoxic pulmonary vasoconstriction, one lung ventilation, positive end expiratory pressure, tracheal anatomy, lung isolation

scholarly journals Clinical Pearls in Anaesthesia for Pleurectomy/Decortication for Malignant Mesothelioma

2017 ◽  
Vol 11 (1) ◽  
pp. 29-34
Author(s):  
Shagun Bhatia Shah ◽  
Itee Chowdhury ◽  
Laleng Mawia Darlong ◽  
Priyanka Goyal ◽  
Anamica Kansal
Keyword(s):  
Malignant Mesothelioma ◽  
Lung Resection ◽  
Lung Ventilation ◽  
Double Lumen Tube ◽  
Visceral Pleura ◽  
One Lung Ventilation ◽  
Double Lumen ◽  
Lumen Tube ◽  
Lung Isolation ◽  
Lung Motion

Background: For most thoracic surgeries (lung resection, esophagectomy) the main purpose of inserting a double lumen tube for lung isolation is providing space for dissection and preventing lung motion by not ventilating (collapsing) the lung undergoing surgery. Objective: In addition, during pleurectomy/ decortication surgeries, the anaesthetist can indirectly perform the dissection of pleura from the lung without scrubbing, gloving or holding the scalpel. Conclusion: This is accomplished by ventilating the lung undergoing surgery, with large tidal volumes while the surgeon provides static traction to the visceral pleura. These phases alternate with one lung ventilation. A detailed account of anaesthesia for pleurectomy/ decortication follows.

scholarly journals ANAESTHETIC MANAGEMENT OF BRONCHOGENIC CYST IN AN INFANT:- A CHALLENGE- A CASE REPORT

2019 ◽  
pp. 1-2
Author(s):  
Garima Anant ◽  
Aman Kaur Saini
Keyword(s):  
Bronchogenic Cyst ◽  
Lung Ventilation ◽  
Female Child ◽  
Anaesthetic Management ◽  
Double Lumen Tube ◽  
One Lung Ventilation ◽  
Double Lumen ◽  
Lumen Tube ◽  
Lung Isolation ◽  
Single Lumen

A double-lumen tube is an endotracheal tube designed to isolate the lungs anatomically and physiologically. Double-lumen tubes are the most commonly used tubes to provide independent ventilation for each lung. One-lung ventilation or lung isolation is the mechanical and functional separation of the 2 lungs to allow selective ventilation of only one lung. The other lung that is not being ventilated passively deates or is displaced by the surgeon to facilitate surgical exposure for non-cardiac operations in the chest such as thoracic, esophageal, aortic and spine procedures. But due to the larger size and more complex design than the single lumen tube (SLT), intubation with a DLT can be a challenge, especially in paediatric patients. We present a case of 2.5 month female child, weighing 3 kgs , diagnosed antenatally by ultrasound with bronchogenic cyst .Left thoracotomy with excision of cyst was the planned surgery for the patient

scholarly journals Sore Throat or Hoarse Voice with Bronchial Blockers or Double-Lumen Tubes for Lung Isolation: A Randomised, Prospective Trial

2008 ◽  
Vol 36 (6) ◽  
pp. 441-446
Author(s):  
T. Zhong ◽  
W. Wang ◽  
J. Chen ◽  
L. Ran ◽  
D. A. Story
Keyword(s):  
Sore Throat ◽  
Prospective Trial ◽  
Lung Ventilation ◽  
Double Lumen Tube ◽  
One Lung Ventilation ◽  
Double Lumen ◽  
Lumen Tube ◽  
Lung Isolation ◽  
Endobronchial Blocker ◽  
Hoarse Voice

Double-lumen endotracheal tubes and bronchial blockers allow lung isolation for one-lung ventilation. Few studies, however, directly compare these devices. Further, a new endobronchial blocker (Coopdech) is available in some countries. Our primary hypothesis was that bronchial blockers would be associated with less sore throat or hoarse voice than double-lumen tubes. Secondary outcomes were successful one-lung ventilation and surgical access. In this prospective trial, 120 Chinese patients undergoing elective surgery were randomly assigned to one of four groups of 30 patients: Coopdech blocker, Arndt blocker, Univent tube or double-lumen tube. Postoperative sore throat and hoarse voice were assessed in the recovery room and 24 hours after surgery. The incidence and severity of sore throat or hoarse voice was less in the blocker groups than double-lumen tube group: Coopdech 13%, Arndt 20%, Univent 30% and double-lumen tube 60%, P <0.001. The blocker groups did not significantly differ, P=0.28. Compared to the double-lumen tubes the bronchial blockers took about two minutes less to position but five minutes longer for lung deflation. Surgical exposure was uniformly good across the four groups. We conclude that clinical use of the Coopdech endobronchial blocker is similar to the Arndt and Univent blockers and that all three are associated with less sore throat or hoarse voice than double-lumen tubes.

scholarly journals Repeated intermittent hypoxic stimuli to operative lung reduce hypoxemia during subsequent one-lung ventilation for thoracoscopic surgery: A randomized controlled trial

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0249880
Author(s):  
Susie Yoon ◽  
Bo Rim Kim ◽  
Se-Hee Min ◽  
Jaehun Lee ◽  
Jae-Hyon Bahk ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Intermittent Hypoxia ◽  
Thoracoscopic Surgery ◽  
Controlled Trial ◽  
Hypoxic Pulmonary Vasoconstriction ◽  
Lung Ventilation ◽  
One Lung Ventilation ◽  
Randomized Controlled ◽  
Pulmonary Vasoconstriction ◽  
Hypoxia Group

Background An intervention to potentiate hypoxic pulmonary vasoconstriction may reduce intrapulmonary shunt and hypoxemia during one-lung ventilation. Previous animal studies reported that repeated intermittent hypoxic stimuli potentiated hypoxic pulmonary vasoconstriction, but no clinical study has examined the effects of this intervention on hypoxemia during one-lung ventilation. We thus performed a single-center, parallel-group, double-blind, randomized controlled trial to investigate whether repeated intermittent hypoxic stimuli to the operative lung reduce hypoxemia during the subsequent one-lung ventilation for thoracoscopic surgery. Methods Patients undergoing one-lung ventilation were randomized into two groups (n = 68 each). Before one-lung ventilation, in the intermittent hypoxia group, the nondependent lung was not ventilated for 2 min and then ventilated for 2 min while the dependent lung was continuously ventilated. This was repeated five times. In the continuous normoxia group, both lungs were ventilated for 20 min. We measured SpO2, PaO2, FiO2, PaCO2, SaO2, and central venous oxygen saturation during one-lung ventilation. The primary outcome was the number of patients with hypoxemia defined as a SpO2 <95% during one-lung ventilation, which was analyzed with a chi-squared test. Results Hypoxemia was less frequent in the intermittent hypoxia group than in the continuous normoxia group during OLV [6/68 (8.8%) vs 17/68 (25.0%), risk ratio (95% CI) 0.35 (0.15–0.84), p = 0.012]. The PaO2 (p = 0.008 for 30 min and 0.007 for 60 min) and PaO2/FiO2 (p = 0.008 for both) were higher 30 and 60 min after starting one-lung ventilation, and the alveolar-arterial pressure gradient (p = 0.010) and shunt index (p = 0.008) were lower 30 min after starting one-lung ventilation in the intermittent hypoxia group than in the continuous normoxia group. Postoperative adverse events did not differ significantly between groups. Conclusions Repeated intermittent hypoxic stimuli to the operative lung seemed to potentiate hypoxic pulmonary vasoconstriction, and thus reduced hypoxemia during the subsequent one-lung ventilation.

scholarly journals The fraction of Nitrous Oxide in oxygen for facilitating Lung collapse During One-Lung Ventilation with double lumen tube

2020 ◽  
Author(s):  
chao liang ◽  
Yuechang Lv ◽  
Yu Shi ◽  
Jing Cang ◽  
Zhanggang Xue
Keyword(s):  
Nitrous Oxide ◽  
Confidence Interval ◽  
Thoracoscopic Surgery ◽  
Prospective Trial ◽  
Lung Ventilation ◽  
Effective Concentration ◽  
Double Lumen Tube ◽  
Test Results ◽  
Lung Collapse ◽  
One Lung Ventilation

Abstract Backgroud To the best of our knowledge, it is still unclear what is the proper fraction of nitrous oxide(N 2 O) in oxygen(O 2 ) for fast lung collapse. Therefore, we designed this prospective trial to determine the 50% effective concentration (EC 50 ) and 95% effective concentration (EC 95 ) of N 2 O in O 2 for fast lung collapse. Methods We studied 38 consecutive patients undergoing video-assisted thoracoscopic surgery(VATS). The lung collapse score(LCS) of each patient during one lung ventilation was evaluated by the same surgeon. The first patient received 30% N 2 O in O 2 , and subsequent N 2 O fraction in O 2 was determined by the LCS of previous patient using Dixon up-and-down method. The testing interval was set at 10%, and the lowest concentration was 10% (10%, 20%, 30%, 40%, or 50%). The EC 50 and EC 95 of N 2 O in O 2 for fast lung collapse were analyzed using probit test. Results The N 2 O fraction in O 2 at which all patients showed success lung collapse was 50%, according to the up-and-down method. The EC 50 and EC 95 of N 2 O in O 2 for fast lung collapse were 27.7% (95% confidence interval, 19.9%–35.7%) and 48.7% (95% confidence interval, 39.0%–96.3%), respectively. Conclusions In patients undergoing VATS, the EC 50 and EC 95 of N 2 O in O 2 for fast lung collapse were 27.7% and 48.7%, respectively.

The Comparative Study of the Single-lumen Tube and Double-lumen Tube in the Blood Gas Analysis for One-lung Ventilation

1994 ◽  
Vol 27 (4) ◽  
pp. 381
Author(s):  
Su Won Kim ◽  
Byung Young Kim ◽  
Myoung Hoon Kong ◽  
Hae Ja Lim ◽  
Byung Kook Chae ◽  
...  
Keyword(s):  
Lung Ventilation ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Double Lumen Tube ◽  
Blood Gas ◽  
One Lung Ventilation ◽  
Double Lumen ◽  
Lumen Tube ◽  
Single Lumen ◽  
The Comparative Study

scholarly journals A Randomized Controlled Trial Comparing Novel Triple-Cuffed Double-Lumen Endobronchial Tubes with Conventional Double-Lumen Endobronchial Tubes for Lung Isolation

2020 ◽  
Vol 9 (4) ◽  
pp. 977
Author(s):  
Namo Kim ◽  
Hyo-Jin Byon ◽  
Go Eun Kim ◽  
Chungon Park ◽  
Young Eun Joe ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Fiberoptic Bronchoscopy ◽  
Lung Ventilation ◽  
One Lung Ventilation ◽  
Double Lumen ◽  
Lung Isolation ◽  
Significant Difference ◽  
Initial Placement ◽  
The Difference ◽  
Double Lumen Endobronchial Tube

Placing a double-lumen endobronchial tube (DLT) in an appropriate position to facilitate lung isolation is essential for thoracic procedures. The novel ANKOR DLT is a DLT developed with three cuffs with a newly added carinal cuff designed to prevent further advancement by being blocked by the carina when the cuff is inflated. In this prospective study, the direction and depth of initial placement of ANKOR DLT were compared with those of conventional DLT. Patients undergoing thoracic surgery (n = 190) with one-lung ventilation (OLV) were randomly allocated into either left-sided conventional DLT group (n = 95) or left-sided ANKOR DLT group (n = 95). The direction and depth of DLT position were compared via fiberoptic bronchoscopy (FOB) after endobronchial intubation between the groups. There was no significant difference in the number of right mainstem endobronchial intubations between the two groups (p = 0.468). The difference between the initial depth of DLT placement and the target depth confirmed by FOB was significantly lower in the ANKOR DLT group than in the conventional DLT group (1.8 ± 1.8 vs. 12.9 ± 9.7 mm; p < 0.001). In conclusion, the ANKOR DLT facilitated its initial positioning at the optimal depth compared to the conventional DLT.

Sign in / Sign up

Export Citation Format

Share Document