As a cardiothoracic anesthesiologist, lung isolation (selectively ventilating only one lung) is an important technique I utilize for surgeries ranging from pneumonectomies and video-assisted thoracoscopic surgeries to minimally-invasive left ventricular assist device (LVAD) implantation. Furthermore as an intensivist, it’s a procedure that can protect a healthy lung from contralateral pathology (ie, pulmonary hemorrhage, necrotizing pneumonia, etc.)
The double lumen endotracheal tube (DLT) is considered the “gold standard” to perform 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 (ie, 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 constantly throughout 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 actually isolated. The VivaSight-DL comes with a ventilator circuit Y-adapter that allows the anesthesiologist to turn off airflow through a particular lumen using a rotator. I still like to use a traditional cross clamp though! 😉
Drop me a comment below with questions! 🙂