Lung isolation for emergent thoracotomy in the bleeding airway patient: the choice of bronchial blocker may make a difference

Relevance of single-lumen endotracheal tube diameter and type of bronchial blocker for lung isolation in an emergent case

“…We would like to add some comments to the clarification that Grocott 1 provided about the published paper by Almeida et al, 2 “Use of bronchial blocker in emergent thoracotomy in presence of upper airway hemorrhage, and cervical spine fracture: a difficult decision”.…”

“…Grocott 1 reminded the readers that the minimum diameter ETT to perform lung isolation with an EZ Blocker™ Teleflex, Morrisville, USA, under fiberoptic visualization is considered 7 mm. In this case, a thin bronchoscope Ambu aScope S slim 3.8/1.2™, Ambu A/S, Ballerup, Denmark (outer diameter: 3.8 mm) was used, which would allow simultaneous use of the EZ Blocker™ through the SLT.…”

“…If there was significant endobronchial hemorrhage ad initium the fiberoptic visualization would be affected, which would compromise the initial positioning of any BB or Double Lumen Tube (DLT). In that case, theoretically, a blind utilization of BB as Arndt blocker™ (Cook Critical Care Inc., Bloomington, IN) or similar (as mentioned by Grocott), 1 Univent™ endobronchial tube (Fuji Systems Corporation, Tokyo, Japan) or DLT could be better options, because the rate that both extremities of EZ Blocker™ enter in the same bronchus at the first attempted is elevated. 3 …”

“…The usefulness of the utilization of bronchial blockers, placed blindly, namely the Univent™ endobronchial tube, for the tamponade of endobronchial hemorrhage has been reported. 1 However, there is no significant evidence comparing the success rate of the first passage between different bronchial blockers, namely when their insertion is performed blindly. Despite Grocott et al 4 have shown that, comparing with DLT, the Arndt Blocker™ took a similar amount of time to provide lung isolation in mini-thoracotomy cases, a systematic meta-analyse has shown that in lung isolation cases, DLT are placed quicker and more reliably that BB (in general).…”