Although double lumen endotracheal tubes (ETTs) remain the gold standard for lung isolation for lateralized pulmonary hemorrhage/infection, massive bronchopleural fistulas, or to facilitate surgeries, it’s important for my trainees to understand all the available options they have when it comes to airway management.
The Univent ETT offers a dedicated channel for a bronchial blocker steered into position under bronchoscopic visualization. After tracheal intubation in the standard fashion and inflation of the tracheal cuff, a bronchoscope is advanced through the main lumen to guide the bronchial blocker into position. At that point, the blocker’s cuff can be inflated to isolate the region of interest.
A disadvantage shared by all bronchial blockers is the inability to effectively suction the isolated lung segment(s). This sometimes makes it difficult to not only remove secretions but facilitate lung deflation. For this reason, I like to keep patients on 100% oxygen prior to isolation and rely on absorption atelectasis to help with lung collapse. For patients who remain intubated post-operatively, the blocker can simply be removed and the Univent managed like any other single lumen ETT making it nice for ICUs that aren’t accustomed to double lumen ETTs.
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