Rigid Bronchoscopic Placement of Fogarty Catheter as a Bronchial Blocker for One Lung Isolation and Ventilation in Infants and Children Undergoing Thoracic Surgery: A Single Institution Experience of 27 Cases

Abstract

One-lung ventilation (OLV) is a challenging task in infants and children as few techniques are possible because of narrow anatomy. The aim of this study is to evaluate and experience lung isolation with Fogarty catheters as a bronchial blocker placed by rigid bronchoscope for OLV in infants and children with lung pathologies requiring surgical management in an industrial hospital. This study is a prospective study carried out in J.L.N. Hospital and Research Centre, Bhilai (CG), from January 2011 to December 2014. The study was designed to place Fogarty catheter for achieving OLV using rigid bronchoscope in children. The patient and anaesthesia characteristics, placement and positioning of Fogarty catheters, intraoperative course, complications and recovery of the patient were studied. The data were then compared with the relevant and available literature. Over the study period of 4 years, 27 cases were included, out of which 22 (81.48 %) cases had suppurative lung disease, three cases (11.11 %) had hydatid cyst of the lung, whereas one case (3.7 %) each of congenital lobar emphysema and congenital cystic adenomatoid malformation of the lung, respectively. In all cases general anaesthesia was provided using single lumen endotracheal tube and one lung ventilation achieved by parallel placement of Fogarty catheter as a bronchial blocker with rigid bronchoscope. The surgical management included thoracotomy with decortication in 21 cases, thoracotomy with excision of hydatid cyst in 3 cases, video-assisted thoracoscopic surgery, thoracotomy with left upper lobectomy and thoracotomy with left lower lobectomy in one case each, respectively. There were no major intraoperative and postoperative complications. There was no mortality in our study. We conclude that rigid bronchoscope can be safely and effectively used to place Fogarty catheter in main bronchus in infants and children for achieving OLV.

Keywords: Bronchial blocker; Bronchoscopy; Fogarty catheters; One-lung ventilation (OLV).

Fig. 1

Clinical photograph showing the placement method steps. a Step 1—Induction of anaesthesia. b Step 2—chosen size Fogarty catheter is placed in the trachea and bronchus with tilt of neck on either side at an approximate measured length. c Step 3—rigid ventilating bronchoscope of appropriate size is inserted. d Step 4—confirmation of the placement of Fogarty catheter in the chosen bronchus with manipulation of Fogarty. e Step 5—forceps is utilized for correct placement of Fogarty catheter at about 1 cm from carina. f Step 6—the balloon is inflated with recommended amount of air under bronchoscopic vision. g Year-wise distribution of cases. h Age and sex distribution

Fig. 2

Photograph showing a Fogarty catheters of different sizes 3fr, 4fr and 5fr. b Fogarty catheters with their respective maximum capacity. c Fogarty catheters of size 3fr and 5fr with inflated balloon. d Bronchoscopic view showing left bronchial blockade with inflated balloon of 3fr Fogarty catheter

Fig. 3

a X-ray chest PA view showing right-sided empyema thoracis. CT scan thorax, b coronal view, c sagittal view and d axial view showing right sided empyema thoracis (pyopneumothorax) with partial collapse with consolidation right lower lobe

Fig. 4

a X–ray chest PA view (pre-operative) showing large sized cystic lesion in left lobe—hydatid cyst. CT scan thorax, b coronal view, c axial view showing large cystic lesion and d X-ray chest PA view (post-operative) showing expanded left lung with ICD tube in situ

Fig. 5

a X-ray chest PA view showing variable sized cystic lesions in left lower lobe? adenomatoid malformation. CT scan thorax, b coronal view, c axial view showing air filled cysts of various sizes in bilateral lower lobe suggestive of congenital cystic adenomatoid malformation type 1 (CCAM)

Fig. 6

CT scan thorax, a coronal view, b axial view showing emphysematous changes in left upper lobe suggestive of congenital lobar emphysema