How Effective is Single Lung Ventilation with Double endotracheal tubes?

Recently published research paper discusses the effectiveness of single lung ventilation (SLV) using a double lumen tube (DLT) for providing surgical exposure in the thoracic cavity. It emphasizes the protective benefits of SLV for a healthy lung, highlighting the types of unhealthy lung fluids it protects from, such as blood, lavage fluid, malignant, or purulent secretions. Correct placement is emphasized and confirmed by endotracheal tubes (FOB).

The paper presents an alternative technique to the DLT in SLV without the use of a FOB, which involves inserting two endotracheal tubes (ETT) in the trachea. The study found that this technique can be effective in achieving lung separation and selective lung ventilation. The benefits of this technique include its flexibility, ease of use, and potential availability in low-resource settings where DLT and FOB may not be readily available.

Challenging Cases and Successful Utilization of New Technique -

The paper provides detailed descriptions of two challenging cases where this new technique was utilized, demonstrating successful lung isolation with no adverse consequences and maintaining oxygen saturation above 90%. The authors also mention the potential advantages of this technique in facilitating surgical procedures and managing difficult cases, such as patients with severe airway obstruction or frailty.

Potential Concerns with the New Technique -

However, the paper acknowledges potential concerns with the new technique, such as an increased risk of bleeding and airway trauma, as well as potential challenges in patients with anticipated difficult airways. The authors suggest that further clinical studies with larger sample sizes are needed to determine the value and potential applications of this technique, including in the ICU setting.

Paper's Overall Insights and Conclusion -

Overall, the paper provides valuable insights into an alternative approach for selective lung ventilation without the use of a fiberoptic bronchoscope, highlighting its potential benefits and areas for further investigation.

Key Points -

- The paper discusses the effectiveness of single lung ventilation (SLV) using a double lumen tube (DLT) for providing surgical exposure in the thoracic cavity, emphasizing the protective benefits of SLV for a healthy lung and correct DLT placement confirmed by a fiberoptic bronchoscope.

- An alternative technique to DLT in SLV without a fiberoptic bronchoscope is presented, involving the insertion of two endotracheal tubes (ETT) in the trachea, with the study finding this technique effective in achieving lung separation and selective lung ventilation. The technique's benefits include flexibility, ease of use, and potential availability in low-resource settings.

- The paper provides detailed descriptions of challenging cases where the new technique was utilized successfully, mentions potential concerns such as increased risk of bleeding and airway trauma, and suggests the need for further clinical studies with larger sample sizes to determine the value and potential applications of the technique.

Reference –

Alsamman H, Bui A, Howard J, et al. (April 25, 2023) An Alternative Approach for Selective Lung Ventilation. Cureus 15(4): e38126. DOI 10.7759/cureus.38126