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Indications for One-Lung Ventilation (OLV)
  • Prevent contamination of healthy lung
    • Purulence
    • Bleeding
  • 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
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DLETT versus Bronchial Blockers
DLETTBronchial blocker
  • 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
  • Unstable
  • Becomes SLETT when bronchial blocker not in place
  • Specific relative indications:
    • Expected difficult intubation
    • Need for RSI
    • Severe hypoxemia
    • Postop ventilation
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Single-Lumen Tubes
SLT sizeID (mm)OD (mm)

For comparison, the inner (ID) and outer (OD) diameters (mm) of single-lumen and double-lumen tubes are listed.

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Double-Lumen Tubes
DLT sizeBronchial ID (mm)Tracheal ID (mm)OD (mm)Patient height
354.35.011.7<62 in.
374.55.512.363–68 in.
394.96.01369–72 in.
415.46.513.7>72 in.

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: 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 Morgan GE, Mikhail MS, Murray MJ. Clinical Anesthesiology, 4th ed. Figure ...

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