AIR-19
An Innovative Way to Place Bronchial Blockers in Pediatric Patients
Mohammad S, Cameron S, Teima D, Griffin E, Nesrsta E, Matuszczak
University of Texas Houston Medical Center, Rosenberg, TX, USA
Achieving one lung ventilation (OLV) is challenging in the pediatric population given the limited options available. From the operative side, carbon dioxide insufflation or retractors can be used to compress the lungs to help provide better surgical exposure. Extraluminal bronchial blockers are difficult to position and keep in position with the nylon loop such as in the Arndt bronchial blocker set. Fogarty catheters are also not ideal given the high pressure low volume balloon where overdistention may damage the airway. We present a different technique that uses the Arndt bronchial blocker set and an angled, half-J tip wire (Terumo Glidewire) instead of the nylon loop, according to Enk.1,2 This wire helps extraluminal placement of the bronchial blocker and allows repeated adjustments throughout the case without very much difficulty. The nylon loop that originally comes in the bronchial set has to be removed to allow for lung deflation, and it cannot be replaced for adjustments of the bronchial blocker in case it becomes dislodged. On the other hand, the angled wire is stiffer and can be removed and replaced through the bronchial blocker during the case. The use of this technique also minimizes the time to place the bronchial blocker. It is first placed during direct laryngoscopy prior to endotracheal tube (ETT) placement. The position is later adjusted once in the lateral decubitus position by placing a fiber optic scope through the ETT. We then twist the distal end of the wire to point the angled tip toward the desired bronchus and advance the bronchial blocker. The balloon, in the desired position, is inflated under fiber optic visualization.
We are presenting three pediatric cases where the bronchial blocker with the Terumo Guidewire was successfully used. A 4-month-old underwent left thoracotomy for division of a vascular ring, a 6-month-old underwent thoracoscopic congenital pulmonary airway malformation (CPAM) resection, and a 4-year-old underwent video-assisted thoracoscopic surgery washout and decortication for recurrent pneumonia. The 4-month-old and the 4-year-old patients had a successful one lung ventilation throughout the case with the bronchial blocker in place. The 6-month-old with CPAM had the bronchial blocker placed for nine hours. Multiple adjustments were needed throughout the case due to extensive surgical manipulations. The lung was deflated and inflated multiple times which would not have been possible without the described technique. The angled tip of the guidewire allows for easy maneuvering to left or right bronchi, and the low pressure high volume cuffed bronchial blocker is placed under fiber optic visualization. The number of cases using this technique successfully is still growing, and we will continue to record the use of this technique to provide one lung isolation in pediatric cases.
References:
1. Enk D, Enk S: Catheter with positioning system. Patent application 10 2013 100 991.3. German Patent Office; January 31, 2013
2. Enk D, Enk S: Catheter with positioning system. Patent application PCT/EP2014/051625. European Patent Office; January 28, 2014
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