Independently controlling ventilation to each lung requires some form of lung isolation. This technique is a pivotal part of managing thoracic trauma and facilitating surgery in the chest (VATS, thoracoabdominal aneurysm repairs, esophagectomies, etc). Although a double lumen endotracheal tube (DL ETT) is considered the “gold standard”, bronchial blockers can certainly be used for more selective isolation of a particular lung segment under bronchoscopic visualization. In this case, the blocker is snared onto a bronchoscope which is passed into the region of interest through a single lumen ETT. The snare is released and the blocker is advanced into the desired position with subsequent inflation of a balloon to occlude that portion of the airway.
Similarly, a Fogarty balloon catheter can be placed through an ETT and inflated once appropriately positioned. Here’s an image of a 6 French Fogarty balloon catheter passed through an Arndt bronchial blocker adapter. This adapter has connections for the ventilator circuit and the ETT and ports to pass the bronchoscope and Fogarty/bronchial blocker. I also attached a 3-way stopcock onto the catheter to regulate balloon inflation/deflation.
I try to teach my residents and fellows a wide variety of options when it comes to airway management. This is just another one to add to their arsenal!
Drop me a comment below with questions! 🙂
What is your preferred way of achieving lung isolation for a patient with a tracheostomy (new or old)? Thanks!