I rencently had the challenging task of giving a single lung ventilation to a 5 year-old 25kg child who had been in a traffic accident and had a large hemothorax. The surgeons wanted to explore and repair on one lung if possible. The case was urgent enough for there to be no time to transfer to a dedicated pediatric hospital.
I managed to put a standard 5.5 ETT into the right main bronchus, with a big enough leak to allow the left lung to deflate. The surgeons were happy with their access and the bleeder was repaired.
My problems started when the surgeons requested repeated inflations and deflations of the left lung to identify persisting air leaks. I managed to pull the tube back and pass it down again several times, each time hoping it would go back into the right main bronchus. This worked well but was a very cumbersome technique.
I thought about putting in a Fogarty catheter as a bronchial blocker, but could not fit the catheter and bronchoscope together down the lumen. My smallest double lumen tube was a 32F - too big for this child.
Any other ways of tackling this situation?
I managed to put a standard 5.5 ETT into the right main bronchus, with a big enough leak to allow the left lung to deflate. The surgeons were happy with their access and the bleeder was repaired.
My problems started when the surgeons requested repeated inflations and deflations of the left lung to identify persisting air leaks. I managed to pull the tube back and pass it down again several times, each time hoping it would go back into the right main bronchus. This worked well but was a very cumbersome technique.
I thought about putting in a Fogarty catheter as a bronchial blocker, but could not fit the catheter and bronchoscope together down the lumen. My smallest double lumen tube was a 32F - too big for this child.
Any other ways of tackling this situation?