At that point, the bronchial lumen will be responsible for ventilating that lung while the tracheal lumen ventilates the other. When the bronchial cuff (which resides in either the right or left mainstem) is inflated, airflow out of the tracheal lumen will “hit” the bronchial cuff. Similar to a conventional single lumen endotracheal tube (SLT), the tracheal cuff and tracheal lumen are both situated within the trachea proximal to the carina and allow airflow in both lungs.
RIGHT-sided double-lumen endotracheal tube (DLT) Instead, the right-sided DLT has a special RUL lumen that needs to be appropriately positioned facing the RUL takeoff. If the right-sided DLT was not specially designed, its bronchial cuff could potentially occlude this RUL takeoff. In particular, the right upper lobe’s ( RUL) takeoff originates very proximal in the right mainstem. Therefore, one must consider airway anatomy to ensure appropriate positioning.
Although these tubes are initially advanced into the airway with laryngoscopy, their final position is confirmed with bronchoscopy. The laterality refers to where the tube’s bronchial cuff resides (left mainstem or right mainstem). In my practice, these are what I use the most for complete, unilateral lung isolation.ĭLTs come in two flavors: left-sided and right-sided. In contrast, DLTs permit small catheters to suction distal to the area of isolation which promotes lung collapse, secretion sampling, lavage, etc. This is necessary to “protect” healthy lung tissue from hemorrhage or infection, isolate a bronchopleural fistula, perform unilateral lung lavage, or facilitate video-assisted thoracoscopic surgeries.Īlthough bronchial blockers are another option for lung isolation (especially for selective lobe isolation), anecdotally, they tend to move and do not allow suctioning beyond the blocker’s cuff.
Double lumen endotracheal tubes ( DLTs) are considered the gold standard for lung isolation – a procedure where we selectively ventilate a single lung or lobe.
0 kommentar(er)
