New device and technique for lung deflation in bronchial blocker.

Editor,

The double-lumen tube has been called ‘a difficult tube’ for its difficult tracheal intubation and bronchial positioning.[1] Therefore, in patients with difficult airways, the safest approach is to place a single-lumen endotracheal tube, and achieve lung isolation in these patients with a bronchial blocker for one-lung ventilation (OLV).[2,3] But lung deflation with a bronchial blocker is time-consuming, because adequate suctioning of the operative lung is difficult through the narrow lumen of a bronchial blocker catheter[2,4] Thus, in order to accelerate the speed of lung deflation using a bronchial blocker, a number of techniques have been developed, including disconnection (apnoea) and the use of continuous bronchial blocker suction techniques.[5] However, the disconnection technique may carry a risk of blood or infected secretions contaminating the dependent lung resulting in hypoxaemia or hypoxia in patients with poor lung function, with the attendant morbidities.[5,6]

We report a new method to make lung deflation faster with a bronchial blocker by continuous bronchial suction technique using a modified device, an intravenous T-connector extension set (Perfect Medical Ind. Co., Ltd., Pei Dou Zhen, Changhua Hsieh, Taiwan R.O.C., Vietnam) and a handmade oblique-cut tracheobronchial suction catheter (BSUP14; Symphon Medical Technology Co., Ltd., Taiwan). After tracheal intubation with a single-lumen endotracheal tube (I.D. 7.0 mm for women and 7.5 mm for men), a bronchial blocker (Fuji Uniblocker; Fuji Systems, Tokyo, Japan) was introduced to the targeted bronchus. The correct position was confirmed with the fibreoptic bronchoscope and auscultation. After skin sterilisation, the blue balloon of the bronchial blocker was inflated. We then connected the modified device (Fig. 1) and applied continuous suction with pressure of −30 cmH2O from the suction port of the bronchial blocker until pleural opening and the operative lung deflation. With this technique, we found OLV with operative lung collapse and pleural opening (Fig. 2) easier. This technique is simple to perform and may reduce risks of hypoxaemia compared with the more conventional apnoea technique.

Fig. 1

Continuous bronchial suction technique using a modified device of an i.v. T-connector extension set and oblique-cut suction tube.

Fig. 2

Good one-lung ventilation after pleural opening.

However, continuous aspiration via a suction port carries a risk of causing obstruction of the bronchial blocker's aspiration channel by pulmonary secretions or blood resulting from surgical manipulations, especially during lung re-expansion. Although this device seems effective to quickly achieve lung collapse, it cannot be advocated, in the current state of knowledge, as a technical support for all surgery.