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Case report: pulmonary soiling after one-lung ventilation with a bronchial blocker

[Observation : contamination pulmonaire à la suite de la ventilation unilatérale avec un bloqueur bronchique]

From the Department of Anesthesiology and Clinical Research Institute, Seoul National University Hospital, Seoul, Korea.

Dr. Jae-Hyon Bahk, Department of Anesthesiology and Clinical Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, 28 Yongon-Dong, Chongno-Gu, Seoul 110-744, Korea. Phone: 82-2-760-2818; Fax: 82-2-747-5639; E-mail: bahkjh{at}plaza.snu.ac.kr

Purpose: To report a case of pulmonary soiling of the dependent and of the non-dependent remaining lung when a Univent tube was used to achieve one-lung ventilation (OLV).

Clinical features: A 61-yr-old, 158-cm, 61-kg woman was scheduled for the resection of a lung cancer in the left lower lobe. An internal diameter 7.0-mm Univent tube was inserted under direct laryngoscopy and positioned via fibreoptic bronchoscopy. Prior to termination of OLV, there was no discharge through the blocker’s lumen, aspirated just before deflating the cuff. As soon as the cuff was deflated, however, abundant blood-tinged secretions were aspirated. At the end of the operation, the chest radiograph showed haziness in the right upper lobe and in the remaining left upper lobe. The ineffective removal of secretions through the lumen of the blocker may be one of its main disadvantages. The bronchial blocker is always placed in the non-dependent bronchus for OLV, which may increase the probability of contaminating the dependent lung. Before deflating the blocker, we recommend the steep Trendelenburg position and the presence of a fibreoptic bronchoscope with a suction port at the tracheal carina to prevent overflow of secretions and soiling of the dependent lung.

Conclusion: Whenever a bronchial blocker is used for OLV, we should be cautious about the possibility that secretions accumulated distal to the blocker may contaminate the dependent or the non-dependent remaining lung.