Failure to Separate and Isolate the Lungs with an Endotracheal Tube Positioned in the Bronchus

Lammers, Cathy R.; Hammer, Gregory B.; Brodsky, Jay B.; Cannon, W. B.

doi:10.1097/00000539-199710000-00048

Cited by 15 publications

(3 citation statements)

References 2 publications

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“…A fibreoptic bronchoscope may be passed through the ETT to confirm or guide placement. When a cuffed ETT is used, the distance from the tip of the tube to the proximal cuff must be shorter than the length of the bronchus so that the cuff is entirely within the bronchus and the upper lobe bronchial orifice is unobstructed (6).…”

Section: Single‐lumen Endotracheal Tubementioning

confidence: 99%

Single‐lung ventilation in infants and children

Hammer

2004

Pediatric Anesthesia

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During the past decade, the use of video-assisted thoracoscopic surgery (VATS) has dramatically increased in children as well as adults. Although VATS can be performed while both lungs are being ventilated, single-lung ventilation (SLV) is desirable during VATS. In addition, anaesthesiologists are performing (and paediatric surgeons are requesting) SLV more frequently for open thoracotomies in infants and children.

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Section: Single‐lumen Endotracheal Tubementioning

confidence: 99%

Single‐lung ventilation in infants and children

Hammer

2004

Pediatric Anesthesia

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“…of insertion depth, is not possible with cuffed tracheal tubes, while in uncuffed tracheal tubes, it works well 20,21 . Insufficient insertion length of the tube leads to partial or full position of the cuff above the carina 22 . On the other hand, the longer distance from tube tip to upper cuff border in cuffed tracheal tubes, compared with the upper margin of the Murphy eye in uncuffed tracheal tubes, results in more situations with obstruction of the left upper lobe bronchus by cuffed tracheal tubes, whereas on the right side, the upper lobe bronchus is blocked by all tube types and sizes.…”

Section: Discussionmentioning

confidence: 99%

Simulated dimensional compatibility of uncuffed and cuffed tracheal tubes for selective endobronchial intubation in children

Moser

Kemper

Dullenkopf

et al. 2020

Pediatric Anesthesia

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Background Cuffed tracheal tubes have recently been recommended for selective endobronchial intubation to establish single‐lung ventilation even in smaller children. This implies that, compared with uncuffed tracheal tubes, the cuffed tracheal tubes selected will be smaller and therefore have a shorter length. We hypothesized that cuffed tracheal tubes might be of insufficient length for selective endobronchial intubation if the tube cuff were fully immersed in the left or right mainstem bronchus. Methods The distance from the proximal end of the tracheal tube to the upper border of the cuff in cuffed tracheal tubes and to the upper margin of the Murphy eye in uncuffed tracheal tubes, respectively, was assessed in sizes 3.0–7.0 mm internal diameter. The raw data sets of two previously performed studies obtained from 337 children aged from birth to 16 years, including the distances “teeth to tracheal tube tip” and “tracheal tube tip to carina,” were used to calculate age‐, weight‐, and height‐related data for the distance from “teeth to carina.” Tracheal tube dimensions were compared with age‐related distances from “teeth to carina,” applying published recommendations for the selection of uncuffed and cuffed tracheal tubes for selective endobronchial intubation in children. Results The differences between the length of the age‐related tracheal tube and the tracheal tube insertion length required to guarantee full insertion of the tracheal tube cuff or the Murphy eye within the mainstem bronchus ranged from −3.5 to 52.6 mm in cuffed tracheal tubes and from 42.3 to 83.3 mm in uncuffed tracheal tubes. Conclusions For many age groups of patients requiring selective endobronchial intubation, the lengths of cuffed tracheal tubes, in contrast to those of uncuffed tracheal tubes, were revealed to be critically short for safe taping outside the oral cavity with the cuff placed completely within the right or left mainstem bronchus.

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“…While several articles have reported surgical techniques for thoracoscopy, anesthetic characteristics including clinical effect, tolerance, and management are poorly documented. [7][8][9][10][11][12] The aim of this retrospective study was to describe anesthesia practice in our institution and to compare the two techniques for the mono-pulmonary ventilation in newborns and infants.…”

Section: Introductionmentioning

confidence: 99%

Anesthetic Management of Pulmonary Surgery in Newborns and Infants

Caruselli

Galvagni

Boubnova³

et al. 2020

Pediatric Reports

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The main congenital pulmonary airways malformations in newborns and infants requiring surgery are cystic adenoid malformation, congenital lobar emphysema and bronchogenic cyst. The surgical treatment preferably via thoracoscopy is recommended within the first year of life to avoid the risk of pneumopathy. A monopulmonary ventilation is then required by the surgeon to operate the diseased lung. The anesthetic management of intraoperative mono-pulmonary ventilation in newborns and infants is always challenging for the anesthesiologist. The main objective of this study was to describe anesthetic protocol for thoracoscopy and variations of monitored parameters during a mono-pulmonary ventilation procedure in newborns and infants.

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Failure to Separate and Isolate the Lungs with an Endotracheal Tube Positioned in the Bronchus

Cited by 15 publications

References 2 publications

Single‐lung ventilation in infants and children

Single‐lung ventilation in infants and children

Simulated dimensional compatibility of uncuffed and cuffed tracheal tubes for selective endobronchial intubation in children

Anesthetic Management of Pulmonary Surgery in Newborns and Infants

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