Bronchial rupture following endobronchial blocker placement: a case report of a rare, unfortunate complication

Background Lung separation may be achieved through the use of double lumen tubes or endobronchial blockers. The use of lung separation techniques carries the risk of airway injuries which range from minor complications like postoperative hoarseness and sore throat to rare and potentially devastating tracheobronchial mucosal injuries like bronchus perforation or rupture. With few case reports to date, bronchial rupture with the use of endobronchial blockers is indeed an overlooked complication. Case presentation A 78-year-old male patient with a left upper lobe lung adenocarcinoma underwent a left upper lobectomy with a Fuji Uniblocker® as the lung separation device. Despite an atraumatic insertion and endobronchial blocker balloon volume within manufacturer specifications, an intraoperative air leak developed, and the patient was found to have sustained a left mainstem bronchus rupture which was successfully repaired and the patient extubated uneventfully. Unfortunately, the patient passed on in-hospital from sepsis and other complications. Conclusion Bronchial rupture is a serious complication of endobronchial blocker use that can carry significant morbidity, and due care should be exercised in its use and placement. Bronchoscopy should be used during insertion, and the volume and pressure of the balloon kept to the minimum required to prevent air leak. Bronchial injury should be considered as a differential in the presence of an unexplained air leak.

Congenital Bronchobiliary Fistula: A Case Report and Literature Review

Congenital bronchobiliary fistula (CBBF) is a rare disease. Children with CBBF mostly have atypical clinical manifestations that can be easily missed. We report a case of a child with CBBF who was diagnosed with fistulography with the help of an endobronchial blocker and a fiberoptic bronchoscope. The CBBF was successfully removed by thoracoscopic surgery.

One Lung Ventilation Using an Orotracheal Tube and an Endobronchial Blocker in a Patient with Difficult Airway

One-Lung Ventilation (OLV) is achieved in thoracic surgeries to facilitate collapse of one lung for better surgical visualisation. Double-lumen tubes and bronchial blockers are two commonly used devices for OLV. Patients with ‘difficult airway’ pose significant challenges for insertion of Double Lumen Endotracheal Tube (DLT). Dual malignancy such as carcinoma of lung and head and neck is extremely rare to present with. Patients presenting with restricted mouth opening due to previous surgeries and requiring lung isolation techniques may pose significant challenges to anaesthesiologist. The difficult airway scenario may arise in such patients owing to their previous surgery to the tongue, larynx, neck, mandible or previous radiation. The present case was of 47-year-old of lung isolation achieved in a patient with restricted mouth opening with an orotracheal tube, bougie, endobronchial blocker and a flexible Fibre Optic Bronchoscope (FOB). Left upper lobectomy was successfully performed after passing endobronchial blocker through a conventional orotracheal tube under the guidance of FOB.

CT- 3-DimenSional airway evaluation-guided intraluminal placement of endobronchial blocker in pediatric patients: a randomized controlled study

Background: One-lung ventilation (OLV) with endobronchial blocking is commonly used in anesthesia for pediatric thoracic surgery. Bronchoscopy is commonly used to guide the endobronchial blocker placement. However, when bronchoscopy is not applicable, the proper placement of endobronchial blocker is challenging. Computed tomography (CT)-3-DimenSional evaluation may be used to accurately measure the airway of pediatric patients. The present study was aimed to propose a new approach of CT-3-DimenSional airway evaluation-guided endobronchial blocker placement in pediatric patients and to determine its efficiency in clinical application. Methods: A total of 127 pediatric patients of 0.5-3 years old scheduled for elective thoracic surgery under OLV were randomized into the bronchoscopy group and the CT group. The degree of lung collapse, postoperative airway mucosal injury, pulmonary infection within 72 hour after surgery, hoarseness after tracheal extubation, Durations of postoperative mechanical ventilation, intensive care unit (ICU) stay, and hospitalization, the successful rate of the first blocker positioning, and the required time and repositionings for successful blocker placement were compared between the two groups. Results: The degree of lung collapse, postoperative airway mucosal injury, pulmonary infection within 72 hour after surgery, hoarseness after tracheal extubation, durations of postoperative mechanical ventilation, ICU stay, and hospitalization were similar between the two groups (all P > 0.05). Conclusions: For pediatric patients who would undergo surgery with OLV, preoperative CT 3-DimenSional airway evaluation could be used to guide endobronchial blocker placement, with a blocking efficiency similar to that of bronchoscopy-guided blocker placement.

Fluoroscopy-Guided Placement of Endobronchial Blockers: A Case Series

ABSTRACT Three cases from a single institution are presented demonstrating a novel technique of endobronchial blocker insertion under fluoroscopic guidance in patients with massive hemoptysis. This article discusses advantages and limitations compared with bronchoscopic and blind insertion techniques. In all three cases, fluoroscopic guidance demonstrated successful insertion with technically appropriate positioning, allowing for hemodynamic stabilization and more definitive interventional treatment. In one case, endobronchial blocker tamponade, itself, was definitive treatment, without recurrence of hemoptysis during the patient's hospital course. All patients had resolution of their hemoptysis and were eventually discharged from the hospital. Fluoroscopy-guided endobronchial blocker insertion was demonstrated to be both technically feasible and effective in these cases of massive hemoptysis. Moving forward, this can be a valuable tool when emergent endobronchial control of hemoptysis is required in certain instances.

CT- 3-DimenSional airway evaluation-guided intraluminal placement of endobronchial blocker in pediatric patients: a randomized controlled study

Background: One-lung ventilation (OLV) with endobronchial blocking is commonly used in anesthesia for pediatric thoracic surgery. Bronchoscopy is commonly used to guide the endobronchial blocker placement. However, when bronchoscopy is not applicable, the proper placement of endobronchial blocker is challenging. Computed tomography (CT)-3-DimenSional evaluation may be used to accurately measure the airway of pediatric patients. The present study was aimed to propose a new approach of CT-3-DimenSional airway evaluation-guided endobronchial blocker placement in pediatric patients and to determine its efficiency in clinical application. Methods: A total of 127 pediatric patients of 0.5-3 years old scheduled for elective thoracic surgery under OLV were randomized into the bronchoscopy group and the CT group. The degree of lung collapse, postoperative airway mucosal injury, pulmonary infection within 72 hour after surgery, hoarseness after tracheal extubation, Durations of postoperative mechanical ventilation, intensive care unit (ICU) stay, and hospitalization, the successful rate of the first blocker positioning, and the required time and repositionings for successful blocker placement were compared between the two groups. Results: The degree of lung collapse, postoperative airway mucosal injury, pulmonary infection within 72 hour after surgery, hoarseness after tracheal extubation, durations of postoperative mechanical ventilation, ICU stay, and hospitalization were similar between the two groups (all P > 0.05). Conclusions: For pediatric patients who would undergo surgery with OLV, preoperative CT 3-DimenSional airway evaluation could be used to guide endobronchial blocker placement, with a blocking efficiency similar to that of bronchoscopy-guided blocker placement.

CT 3-Dimentional Airway Reconstruction-guided Intraluminal Placement of Endobronchial Blocker in Pediatric Patients: A Randomized Controlled Study

Background: The one-lung ventilation (OLV) with endobronchial blocking is commonly used in anesthesia for pediatric thoracic surgery. Bronchoscopy is commonly used to guide the endobronchial blocker placement. However, when bronchoscopy is not applicable, the proper placement of endobronchial blocker is challenging. The computed tomography (CT) 3-dimentional reconstruction may be used to accurately measure the airway of pediatric patients. The present study was aimed to propose a new approach of CT 3-dimentional airway reconstruction-guided endobronchial blocker placement in pediatric patients and to determine its efficiency in clinical application.Methods: A total of 127 pediatric patients of 0.5-3 years old who would undergo elective thoracic surgery under OLV were randomized into the bronchoscopy group and the CT group. The degree of lung collapse, postoperative airway mucosal injury, pulmonary infection within 72 h after surgery, trachyphonia after tracheal extubation, durations of postoperative mechanical ventilation, intensive care unit (ICU) stay, and hospitalization, the successful rate of the first blocker positioning, and the required time and repositionings for successful blocker placement were compared between the two groups.Results: The degree of lung collapse, postoperative airway mucosal injury, pulmonary infection within 72 h after surgery, trachyphonia after tracheal extubation, durations of postoperative mechanical ventilation, ICU stay, and hospitalization were similar between the two groups (all P > 0.05).Conclusions: For pediatric patients who would undergo surgery with OLV, preoperative CT 3-dimentional airway reconstruction could be used to guide endobronchial blocker placement, with a blocking efficiency similar to that of bronchoscopy-guided blocker placement.The trial was registered prior to patient enrollment at China Clinical Trial Registry (http://www.chictr.org.cn/showproj.aspx?proj=4344, Principal investigator: Yingyi Xu, Registration number: ChiCTR-TRC-14005232, Date of registration: 12 August 2014).