From the Guidelines
A bronchial blocker is a crucial medical device used to isolate a lung during severe hemoptysis, consisting of a catheter with an inflatable balloon at its tip that can be positioned in the bronchus of the bleeding lung to prevent blood from flowing into the healthy lung. This technique is essential in emergency situations to maintain oxygenation while preventing aspiration of blood into the healthy lung. According to the most recent study 1, bronchial artery embolization is recommended in the majority of cases of massive hemoptysis, and bronchial blockers can be used to tamponade the bronchus. The procedure requires expertise in airway management and is typically performed by anesthesiologists or pulmonologists in an operating room or intensive care setting.
Key Points
- Bronchial blockers are used to isolate a lung during severe hemoptysis
- They consist of a catheter with an inflatable balloon at its tip
- The balloon is positioned in the bronchus of the bleeding lung to prevent blood from flowing into the healthy lung
- Bronchial blockers are preferred over double-lumen tubes in patients with difficult airways or when prolonged postoperative ventilation is anticipated
- The procedure requires expertise in airway management and is typically performed by anesthesiologists or pulmonologists
Benefits
- Maintains oxygenation while preventing aspiration of blood into the healthy lung
- Crucial in emergency situations
- Can be used to tamponade the bronchus
- Preferred over double-lumen tubes in certain situations
Devices
- Arndt Endobronchial Blocker
- Cohen Flexitip Endobronchial Blocker
- Univent tube These devices are typically inserted through or alongside an endotracheal tube under bronchoscopic guidance, as stated in the study 1. Once positioned in the target bronchus, the balloon is inflated to create a seal, preventing blood from the affected lung from contaminating the healthy lung and allowing the patient to be ventilated through the unaffected lung.
From the Research
Bronchial Blocker for Lung Isolation in Hemoptysis
A bronchial blocker is a device used to isolate a lung in patients with hemoptysis, allowing for one-lung ventilation and preventing airway obstruction and hypovolemic shock 2.
Types of Bronchial Blockers
There are several types of bronchial blockers available, including:
- Fuji Uniblocker (Fuji Systems Corporation, Tokyo, Japan) 2
- Arndt blocker 3, 4
- Cohen blocker 3
- Fogarty embolectomy catheter 4
- Torque control blocker Univent 4
- Wire-guided endobronchial blocker (Arndt blocker) 4
Placement and Positioning
Bronchial blockers can be placed through an endotracheal tube or independently, and their positioning can be guided by fluoroscopy or bronchoscopy 5, 4.
Advantages and Disadvantages
The use of bronchial blockers has several advantages, including the ability to achieve one-lung ventilation in patients with difficult airways 3, 4. However, they also have some disadvantages, such as requiring longer time for placement and assisted suction to expedite lung collapse 4.
Clinical Applications
Bronchial blockers are commonly used in patients with massive hemoptysis, particularly when an involved artery is noted on computed tomography angiography 6. They are also used in patients with difficult airways who require lung isolation for thoracic surgery 3.