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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

 Seo, Yijun  ;  Kim, Namo  ;  Paik, Hyo Chae  ;  Park, Dahee  ;  Oh, Young Jun 
 Medicine, Vol.98(33) : e16869, 2019 
Journal Title
Issue Date
Bronchoscopy/instrumentation* ; Equipment Design ; Female ; Humans ; Idiopathic Pulmonary Fibrosis/complications ; Idiopathic Pulmonary Fibrosis/surgery* ; Intubation, Intratracheal/methods* ; Lung Transplantation/instrumentation ; Lung Transplantation/methods ; Middle Aged ; Obesity/complications ; One-Lung Ventilation/methods*
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.
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1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Namo(김남오) ORCID logo https://orcid.org/0000-0002-0829-490X
Paik, Hyo Chae(백효채) ORCID logo https://orcid.org/0000-0001-9309-8235
Seo, Yijun(서이준)
Oh, Young Jun(오영준) ORCID logo https://orcid.org/0000-0002-6258-5695
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