One lung ventilation strategies for infants and children undergoing video assisted thoracoscopic surgery

Abstract

The advantages of video assisted thoracoscopic surgery (VATS) in children have led to its increased usage over the years. VATS, however, requires an efficient technique for one lung ventilation. Today, there is an increasing interest in developing the technique for lung isolation to meet the anatomic and physiologic variations in infants and children. This article aims to provide an updated and comprehensive review on one-lung ventilation strategies for infants and children undergoing VATS. Search of terms such as ‘One lung ventilation for infants and children’, ‘Video assisted thoracoscopic surgery for infants and children’, and ‘Physiologic changes during one lung ventilation for infants and children’ were used. The search mechanics and engines for this review included the following: Kandang Kerbau Hospital (KKH) eLibrary, PubMed, Ovid Medline, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews. During the search the author focused on significant current and pilot randomized control trials, case reports, review articles, and editorials. Critical decision making on what device to use based on the age, weight, and pathology of the patient; and how to use it for lung isolation are discussed in this article. Furthermore, additional information regarding the advantages, limitations, techniques of insertion and maintenance of each device for one lung ventilation in infants and children were the highlights in this article.

Successful one-lung ventilation by blocking the right intermediate bronchus in a 7-year-old child: a case report

“…8 However, if the bronchial blocker advances proximally when the patient’s position is changed, it can block the trachea and interfere with ventilation; thus, it is better to deflate the balloon prior to the position change and advance the tube about 1 cm before fixation. 10 In the present case, the one-lumen tube was positioned at the trachea, and the Arndt endobronchial blocker was moved into the tube using the bronchoscope. Because the surgical site was in the right lower chest, we positioned the Arndt endobronchial blocker at the right intermediate bronchus after ensuring that the bronchoscope had moved past the right upper lobe bronchus.…”

Use of bronchial blockers for thoracic surgery in pediatric oncology

“…При этом на всех этапах мероприятий по разделению легких (интубация, установка ББ и раздувание его манжеты, контроль стояния ББ) осуществляется видеоконтроль с визуализацией просветов главных бронхов, трахеи и ее бифуркации, что значительно снижает вероятность травматизации этих структур (рис. 3) [6,7,14,17]. Анализ полученных результатов показывает, что эффективность и безопасность ББ сопоставимы с ДПТ.…”

“…Таким образом, перед анестезиологом стоит задача проведения однолегочной вентиляции (ОЛВ) с разделением легких и/или изоляцией легкого на стороне операции. Арсенал технических приспособлений для обеспечения ОЛВ включает: ДПТ, бронхоблокаторы (ББ), однопросветные трубки с двумя манжетамитрахеальной и бронхиальной типа Макинтоша-Литтердейла и типа Гордона-Грина, ДПТ VivaSight со встроенной видеокамерой [4][5][6][7]. Опубликовано большое количество исследований, демонстрирующих преимущества ББ перед другими устройствами (ДПТ и др.)…”

“…Опубликовано большое количество исследований, демонстрирующих преимущества ББ перед другими устройствами (ДПТ и др.) при проведении ОЛВ [4,[6][7][8][9][10][11].…”

Challenges in Anaesthetic management of a child for thoracoscopic assisted oesophageal replacement

“…Therefore, it is necessary to use a device that can ventilate both lungs in the event of hypoxia and provide efficient lung isolation intraoperatively. [ 10 ] Uncuffed ETT was used for OLV because of non-availability of OLV airway devices. The distal end of the ETT was modified to an S-shaped curve with the help of stillete.…”