What devices are used for one lung ventilation?

From the Guidelines

Devices used for one lung ventilation include double-lumen endotracheal tubes (DLTs), bronchial blockers, and univent tubes, with double-lumen tubes being the most commonly used and preferred method due to their efficiency and reliability in experienced hands 1.

Types of Devices

The following devices are used for one lung ventilation:

• Double-lumen endotracheal tubes (DLTs): available in left-sided and right-sided versions, with left-sided DLTs being preferred due to easier placement and lower risk of right upper lobe obstruction
• Bronchial blockers: such as the Arndt blocker, Cohen blocker, and EZ-Blocker, which are inserted through or alongside a single-lumen endotracheal tube and provide an alternative when DLT placement is difficult
• Univent tubes: consist of a conventional endotracheal tube with an integrated bronchial blocker channel

Selection and Placement

Selection of the device depends on patient anatomy, surgical procedure, and provider experience. Proper positioning of the device must be confirmed with fiberoptic bronchoscopy to ensure adequate lung isolation 1.

Clinical Considerations

These devices work by physically separating the lungs, allowing ventilation of one lung while the other is collapsed or separately ventilated, which is essential for thoracic surgeries, management of massive hemoptysis, or isolation of infected lung segments. The choice of device may also depend on the specific surgical procedure, such as minimally invasive mitral valve surgery, where single lung ventilation can be accomplished with either a double lumen endotracheal tube or a single lumen tube and bronchial blocker 1.

Recommendation

Double-lumen endotracheal tubes are the most efficient method for one lung ventilation in experienced hands, and their use is recommended for most thoracic surgical cases 1.

From the Research

Devices Used for One Lung Ventilation

The following devices are used for one lung ventilation:

• Double-lumen endotracheal tubes 2, 3, 4, 5
• Bronchial blockers, including:
  • Fogarty embolectomy catheter 3
  • Univent tube 3, 6
  • Arndt blocker 3, 6
  • Cohen bronchial blocker 6
  • EZ-bronchial blocker (EZB) 4
• Single-lumen endotracheal tube with a bronchial blocker 3, 5

Characteristics of Devices

• Double-lumen endotracheal tubes are faster, easier to place, cheaper, and less prone to malposition than bronchial blockers 2
• Bronchial blockers require longer time for placement, assisted suction to expedite lung collapse, and the use of fiberoptic bronchoscopy 3
• The choice of device depends on individual experience, in-house equipment, and the individual patient 4

Clinical Performance of Devices

• A randomised controlled clinical trial compared the clinical performance of EZB with double-lumen tube (DLT) and found that DLT resulted in shorter total time to obtain successful one lung ventilation 4
• The quality of lung collapse was equal in both groups, but inadequate lung collapse in some patients in the EZB group resulted in unsuccessful repositioning attempts and secondary DLT placement 4
• Endoscopic examinations revealed significantly more carina trauma and subglottic haemorrhage in the DLT group 4