As a cardiothoracic anesthesiologist, lung isolation (selectively ventilating only one lung) is an important technique I utilize for pneumonectomies, video-assisted thoracoscopic surgeries, sternum-sparing left ventricular assist device (LVAD) implantation, open thoracoabdominal aortic aneurysm repair, etc. As an intensivist, I rarely utilize lung isolation in the ICU to protect a healthy lung from contralateral pathologies like pulmonary hemorrhage and focal necrotizing pneumonia or to isolate large bronchopleural fistulas.
The double-lumen endotracheal tube (DLT) is considered the “gold standard” for performing lung isolation. After the airway is secured, each lung can be selectively ventilated through a tracheal and bronchial lumen. However, this relies on the DLT being appropriately positioned under bronchoscopic visualization. When we position patients for surgery (e.g., lateral decubitus), these tubes can migrate, necessitating additional bronchoscopy for repositioning.
The VivaSight-DL is a special DLT containing a built-in high-resolution camera to facilitate tube placement and real-time monitoring of its location throughout the surgery. In the top left portion of the image, the built-in camera was used to guide the blue bronchial cuff into the left mainstem (this was a left-sided DLT). If secretions deposit on this camera, air or fluid can be injected into the flush port to clear them. Otherwise, the rest of the components are identical to traditional double-lumen tubes, with the key exception being how the lung is isolated. The VivaSight-DL comes with a ventilator circuit Y-adapter with rotational valves that allow me to turn off airflow to a particular lumen. I still like to use a traditional cross-clamp though!
Drop me a comment below with questions! 🙂
