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Indications for One-Lung Ventilation (OLV)
AbsoluteRelative
  • 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)
7.07.09.6
7.57.510.2
8.08.010.9
8.58.511.5

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: 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 Morgan GE, ...

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