Indications for One-Lung Ventilation (OLV)
- Prevent contamination of healthy lung
- Need for separate ventilation of lungs
- Bronchopleural fistula
- Unilateral bullae
- Tracheobronchial disruption
- Bronchoalveolar lavage (alveolar proteinosis)
- Video-assisted thoracic surgery
- Lung resection
- Thoracic aortic aneurysm surgery
- Thoracic spine surgery
- Esophageal surgery
DLETT versus Bronchial Blockers
- Allows separate ventilation/exclusion of lungs
- Complete and easy lung deflation
- Stable (but check position each time patient repositioned)
- If patient kept intubated, must be exchanged for SLETT at the end of surgery, or retracted into trachea
- Allows exclusion of one lung, or ventilation of both lungs through the ETT lumen, but not separate ventilation
- Small lumen; lengthy, incomplete deflation
- Becomes SLETT when bronchial blocker not in place
- Specific relative indications:
- Expected difficult intubation
- Need for RSI
- Severe hypoxemia
- Postop ventilation
|SLT size||ID (mm)||OD (mm)|
|DLT size||Bronchial ID (mm)||Tracheal ID (mm)||OD (mm)||Patient height|
There are left- and right-sided DLT—this refers to the bronchus the bronchial port should be in
- The right-sided DLT has a fenestrated bronchial cuff with a hole for the RUL
Left-sided DLT are most commonly used
- Easier to position
- Longer left mainstem bronchus between the carina and the left upper lobe (less likely to occlude LUL)
- Right bronchus shorter in length, risk of obstructing right upper lobe with bronchial balloon is much higher
Indications for right-sided DLT: Surgery involving left mainstem bronchus, or left pneumonectomy
Figure 94-1. Left-Sided (on the Left) and Right-Sided (on the Right) Double-Lumen ETT
Note the fenestrated bronchial cuff of the right-sided DLETT. The opening should be aligned with the right upper lobe bronchus. Reproduced from Morgan GE, Mikhail MS, Murray MJ. Clinical Anesthesiology. 4th ed. Figure 24-6. Available at: www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.
Figure 94-2. Technique of Insertion of DLETT
(A) The tube is inserted with the distal convexity facing down. (B) Once through the vocal cords, it is advanced AND rotated 90°C: the bronchial tip enters the left bronchus and resistance is felt when the DLT is in correct position. Reproduced from ...
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