Medicine
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Clinical Case Report
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Successful blind lung isolation with the use of a novel double-lumen endobronchial tube in a patient undergoing lung transplantation with massive pulmonary secretion A case report Yijun Seo, MDa,b, Namo Kim, MD, PhDa,b, Hyo Chae Paik, MD, PhDc, Dahee Park, MDa, ∗ Young Jun Oh, MD, PhDa,b, Abstract Rationale: Precise lung isolation technique with visual confirmation is essential for thoracic surgeries to create a safe and clear
surgical field. However, in certain situations, such as when patients have massive pulmonary secretion or when the fiberoptic bronchoscopy (FOB) is not applicable, lung isolation has been performed blindly. Patient concern: A 52-year-old woman, whose airway was unable to visualize with FOB due to massive pulmonary secretion, was presented for bilateral sequential lung transplantation. Extracorporeal membranous oxygenation, tracheostomy, and mechanical ventilation were applied to the patient for 39 days preoperatively as a bridge for lung transplantation. Diagnosis: Patient was diagnosed with an idiopathic pulmonary fibrosis and obesity. Intervention: Initially, height-based blind positioning with a conventional double-lumen endobronchial tube (DLT) failed to ventilate the patient properly, and the confirmation of DLT positioning with FOB was impossible due to massive pulmonary secretion. Therefore, a novel DLT (ANKOR DLT) that has one more cuff, located at a point between the distal opening of the tracheal lumen and the starting point of bronchial cuff, than conventional DLT was used for the lung isolation in the patient. Outcomes: After the completion of lung graft, FOB finding showed that the ANKOR DLT was optimally positioned at the
tracheobronchial tree of the patient, and its depth was 2.5 cm shallower than that of the conventional tube. Lessons: ANKOR DLT would be a feasible choice to achieve successful blind lung isolation when the use of FOB is impossible to
achieve the optimal lung isolation. Abbreviations: DLT = double-lumen endobronchial tube, ECMO = extracorporeal membrane oxygenation, FOB = fiberoptic bronchoscopy, POD = postoperative day. Keywords: airway management, idiopathic pulmonary fibrosis, lung transplantation, one-lung ventilation
double-lumen endobronchial lumen (DLT) has been confirmed by fiberoptic bronchoscope (FOB).[1,2] Alternatively, blind lung isolation technique, such as the lung compliance,[3] bronchial cuff pressure change,[4] or height-based assumption,[5] has been used when FOB is unavailable or not applicable in certain situations. Here, we report the successful blind lung isolation by using a novel DLT which has one more cuff than the conventional DLT, developed by one of the authors, in a patient undergoing lung transplantation with massive pulmonary secretion. This would be the first report describing the clinical use of a novel DLT in the literature. Written informed consent for the publication of the clinical details and clinical image were obtained from the patient postoperatively.
1. Introduction Precise lung isolation technique is essential for thoracic surgeries to create a safe and clear surgical field. Ideal positioning of Editor: N/A. Funding: Not applicable. YJO has the patent on the design of ANKORTM double-lumen endobronchial tube, and licenced it out to Insung Medical. Co. Other authors have no conflicts of interest. a
Department of Anesthesiology and Pain Medicine, b Anesthesia and Pain Research Institute, c Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, South Korea. ∗
Correspondence: Young Jun Oh, Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, (03722) 50-1 Yonsei-ro, Seodaemun-gu, Seoul, South Korea (e-mail: yjoh@yuhs.ac).
2. Case report
Copyright © 2019 the Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
A 52-year-old woman (height 159 cm, weight 94 kg) with idiopathic pulmonary fibrosis and obesity was presented for bilateral sequential lung transplantation with right lung graft first under extracorporeal membrane oxygenation (ECMO). Preoperative pulmonary function test (%, predicted) showed forced expiratory volume in 1 second, 0.88 L (37%); forced vital capacity in 1 second, 0.92 L (30%); forced expiratory volume
Medicine (2019) 98:33(e16869) Received: 21 February 2019 / Received in final form: 17 June 2019 / Accepted: 24 July 2019 http://dx.doi.org/10.1097/MD.0000000000016869
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