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One Lung Ventilation

Double-lumen endotracheal tube


The University of Kansas
NURA 833
Fall 2012


Emily A. Covington
Outline
Definition
Indications
Contraindications
Technique & Specifications
Perioperative Considerations
Postoperative Complications
The University of Kansas Hospital
One Lung Ventilation

Alternative to two-lung ventilation
Separates right and left lungs
Provided per surgeon request


Absolute Indications

Required for procedure
Prevention of contamination
Control of distribution
Unilateral bronchopulmonary lavage
Relative Indications

Not required for procedure
Surgical exposure
Unilateral pulmonary embolectomy
Contraindications

Patient refusal
Airway mass
Rapid Sequence Intubation
Difficult Airway


Technique

Double-lumen endotracheal tube
Endotracheal lumen

Endobronchial lumen

Endotracheal
Cuff
Endobronchial
Cuff
Double Lumen Tube
(Ibrahim, n.d.)
Types & Specifications
Carlens White Bryce
Smith
Robertshaw
Lumen
Hook
+ + - -
Side

Left Right Left &
Right
Left & Right
(Ibrahim, n.d.)
Sizing
Height

Tube size
Male
> 170 cm
170 cm
41 F
39 F
Female
> 160 cm
160 cm
37 F
35 F
(OLeary & Duthie, n.d.)
Complications

Bronchial cuff herniation
Malposition
Tracheal rupture
Hypoxemia

Bronchospasm
Decreased cardiac output
Hypoventilation
Intrapulmonary shunting
Pneumothorax
Treating Hypoxemia
http://www.anesthesiologynews.com/download/LungIsolation_ANGAM09_WM.pdf
Ventilation Considerations

Pressure- vs. Volume-controlled
Physiological tidal volumes
Positive end-expiratory pressure
Continuous positive airway pressure
Anesthesia Considerations

Recommendation for treatment
General anesthesia
Thoracic epidural





Induction

Sevoflurane
Propofol, thiopental, ketamine
Short-acting neuromuscular relaxants

Intraoperative

Isoflurane
Opioids
Avoid nitrous oxide
Postoperative Complications

Hoarseness
Airway Obstruction
Vocal cord lesions
Ipsilateral
Damage
Bilateral
paralysis
Obstruction vs. Hoarseness
(Herman, 2002)
Vocal Cord Lesions
Carinal Hook
(Ibrahim, n.d.)
Approach at KU Hospital

Left-sided Mallinckrodt DLT
Robertshaw design

NO carinal hook
Fiberoptic confirmation
Mallinckrodt DLT
Bronchial
limb
Tracheal
limb
Radio-opaque
marking
(Covidien, 2012)
Questions?
References
Covidien. (2012). Specialty endotracheal airways. Retrieved from
http://www.covidien.com/rms/pages.aspx?page=OurBrands/Mallinckrodt
Herman, C. (2002). Medialization thyroplasty for unilateral vocal cord
paralysis. AORN Journal, 75(3), 512-522. doi:10.1016 S0001-
2092(06)61173-3
Ibrahim, A. (n.d.). One lung ventilation [PowerPoint Slides]. Retrieved from
telemed.shams.edu.eg/moodle/pluginfile.php
Levine W. C. (Ed.). (2010). Clinical anesthesia procedures of Massachusetts
General Hospital (8th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Neustein, S. M., Eisenkraft, J. B., & Cohen, E. (2009). Anesthesia for
thoracic surgery. In P. Barash, B. Cullen, R. Stoelting, M. Cahalan, & M.
Stock (Eds.), Clinical anesthesia (6
th
ed., pp. 1032-1072). Philadelphia, PA:
Lippincott Williams & Wilkins.
OLeary, R. & Duthie, D. (n.d.). Double lumen endobronchial tube sizes in
routine practice [PowerPoint Slides]. Retrieved from
www.ctsymposium2012.com/Abstracts/Duthie%20DLT%20size.pptx
Rieker, M. (2010). Anesthesia for thoracic surgery. In J. Nagelhout & K.
Plaus (Eds.), Nurse anesthesia (4
th
ed., pp. 630-650). St. Louis, MO:
Saunders.
Tugrul, M., Camci, E., Karadentz, H., Senturk, M., Pembect, K., & Akptr, K.
(1997). Comparison of volume controlled with pressure controlled ventilation
during one-lung anaesthesia. British Journal of Anaesthesia, 79, 306-310.
Retrieved from http://bja.oxfordjournals.org/content/79/3/306.full.pdf