Methods of lung separation.

Area of Science:

• Thoracic Surgery
• Anesthesiology
• Respiratory Medicine

Background:

• Lung collapse is crucial for video-assisted thoracoscopy (VAT).
• Lung separation is often necessary, posing challenges in patients with difficult airways.
• Standard methods may involve double lumen tubes (DLT) or Univent tubes.

Purpose of the Study:

• To review methods for lung separation during VAT, especially in difficult airway scenarios.
• To highlight available devices and techniques for achieving one-lung ventilation (OLV).

Main Methods:

• Discussion of intubation strategies for difficult airways, including awake fiberoptic intubation.
• Description of techniques for achieving OLV with a single lumen tube (SLT) in place, such as using a tube exchanger or bronchial blockers (BB).
• Introduction of the Cohen Flexitip Endobronchial Blocker as a recent advancement.

Main Results:

• DLT and Univent tubes are options but challenging with difficult airways.
• Bronchial blockers, including the Fogarty catheter and the newer Cohen Flexitip BB, provide alternatives for lung separation.
• The Cohen Flexitip BB features a flexible tip for precise placement and a lumen for suctioning and oxygen insufflation.

Conclusions:

• Clinicians must be proficient in various lung separation techniques for VAT.
• Familiarity with available devices, including advanced bronchial blockers, is essential for patient safety and effective OLV.