Availability of lobe-selective bronchial blockade for video-assisted thoracic surgery

Abstract

Lobe-selective bronchial blockade may be beneficial when VATS is performed for selected patients with deteriorated lung function.

Anaesthetic approach to VATS in a patient with one lung

“…Techniques include high frequency jet ventilation [1-2], use of selective bronchial blockade [3], cardiopulmonary bypass [4] and intermittent apnoea ventilation [5][6]. A variety of treatments have been described ranging from conservative management with chestdrain insertion, simple pleurodesis, bullectomy through to partial lobectomy.…”

“…Anaesthetic management is equally diverse, with specific management depending upon the type of surgical intervention and the patient's pulmonary reserve. Techniques include high frequency jet ventilation [1-2], use of selective bronchial blockade [3], cardiopulmonary bypass [4] and intermittent apnoea ventilation [5][6]. Patients with significant underlying lung disease and poor respiratory reserve generally do not tolerate cessation of ventilation and are managed by the use of selective bronchial blockade or cardiopulmonary bypass.…”

Application of Lobe-Selective Bronchial Blockade against Airway Bleeding

“…Although the idea of combining a double-lumen endotracheal tube and an airway blocker for lobe-selective bronchial blockade has been reported to be an effective method of airway management for various situations, such as airway bleeding, lung abscess, and bronchopleural fistula, there are few reports of the clinical application of this combination for true lobe-selective bronchial blockade. 1,2,6,7 This simple method can be used in a situation that requires protection from blood contamination or abscess aspiration, as well as minimal lobar deflation due to poor lung function. 1,2 A possible alternative to lobe-selective bronchial blockade is direct lobar blockade with a Fogarty occlusion catheter (Edwards Lifesciences, Irvine, CA, USA), or a wire-guided endobronchial blocker (Arndt blocker; Cook Critical Care, Bloomington, IN, USA) placed at the orifice of each lobe.…”

“…1,2,6,7 This simple method can be used in a situation that requires protection from blood contamination or abscess aspiration, as well as minimal lobar deflation due to poor lung function. 1,2 A possible alternative to lobe-selective bronchial blockade is direct lobar blockade with a Fogarty occlusion catheter (Edwards Lifesciences, Irvine, CA, USA), or a wire-guided endobronchial blocker (Arndt blocker; Cook Critical Care, Bloomington, IN, USA) placed at the orifice of each lobe. 6,8 A direct lobar blockade method is applicable for all lobes, however, in this case requiring secure isolation of the right upper lobe, we selected the simple combination of a double-lumen endotracheal tube and an airway blocker positioned and stabilized at the right intermediate bronchus to avoid the concern about possible balloon dislodgement associated with direct occlusion methods.…”

“…The idea of a lobe-selective bronchial blockade technique combining a double-lumen endotracheal tube and a bronchial blocker was described previously, but there are few reports of the actual application of this method. 1,2…”