Lung isolation techniques

Left-sided double-lumen endotracheal tubes should be the tube of choice for most cases in which lung isolation is required. A right-sided double-lumen endotracheal tube can be used effectively when a contraindication to placing a left-sided double-lumen endotracheal tube exists. The method of choice to select left-sided double-lumen endotracheal tubes is based on chest radiograph or CT scan measurements of the trachea or bronchus. Based on clinical reports, Univents or WEB blockers may be a better choice for patients with difficult airways who require one-lung ventilation or for when a selective lobar blockade is needed. For all selective intubation, the method of choice for proper tube placement and bronchial blockade is fiberoptic bronchoscopy with the patient in a supine position at first or in a lateral decubitus position later, or if a malposition occurs.