Although double-lumen endotracheal tubes (ETTs) remain the gold standard for lung isolation for lateralized pulmonary hemorrhage/infection, massive bronchopleural fistulas, or facilitating certain surgeries, my trainees need 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 suction the isolated lung segment(s) effectively. This sometimes makes it difficult to remove secretions and facilitate lung deflation. For this reason, I like to keep patients on 100% oxygen before 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.
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