Endobronchial Intubation to Facilitate Extraluminal Bronchial Blocker Placement in Young Children: A Retrospective Case Series

Abstract

Objectives: Extraluminal bronchial blocker placement has become a well-accepted approach to one-lung ventilation in young children. In some cases, technical issues with placement may require alternative approaches to correct bronchial blocker positioning. The primary aim of this study was to review the authors' experience with using endobronchial intubation to facilitate extraluminal bronchial blocker placement in young children.

Design: Single-center case series of pediatric patients undergoing thoracic surgery and one-lung ventilation using a bronchial blocker.

Setting: Tertiary academic medical center.

Participants: Pediatric patients < three years of age undergoing thoracic surgery and one-lung ventilation who underwent bronchial blocker placement using endobronchial intubation to facilitate blocker placement. In all patients, the bronchial blocker was inserted through a selectively mainstemmed endotracheal tube to facilitate blocker positioning.

Interventions: No interventions were performed.

Measurements and main results: Fifteen patients were identified after a query of the local electronic health record. There were five right-sided and ten left-sided placements in this cohort. Bronchial blocker placement was successful in 14 of 15 patients using endobronchial intubation to facilitate bronchial blocker placement. In one patient, the bronchial blocker was discovered in the nonsurgical bronchus, following placement with this technique. The bronchial blocker was repositioned manually into the desired mainstem bronchus prior to lateral positioning.

Conclusions: Mainstem intubation can be used to facilitate bronchial blocker placement in young children and represents an alternative approach to extraluminal bronchial blocker placement.

Keywords: airway management; endotracheal anesthesia; thoracic surgery.