Methods of lung separation

During video assisted thoracoscopy (VAT) the lung should be well collapsed. When the separation of the lungs is strictly indicated, use of difficult tube, such as double lumen tube (DLT) or Univent tube cannot be avoided, despite the presence of a difficult airway. If a patient has a recognized difficult airway, awake intubation with fiberoptic bronchoscopy can be attempted with Univent tube, DLT or with single lumen tube (SLT). If failure to provide a lung separation could result in a life-threatening situation, there are 2 possibilities to provide a one lung ventilation (OLV) when a SLT is in place: a tube exchanger can be used to position a DLT or a bronchial blocker (BB) can be directed through the SLT in the bronchus. The most used BB is a Fogarty embolectomy catheter. More recently a new BB has been approved by FDA: the Cohen Flexitip Endobronchial Blocker. The most important feature of the blocker is its flexible soft tip that allows to direct it in the desired bronchus. The blocker contains a lumen that allows suctioning of the lung to facilitate deflation, suctioning of secretion and insufflation of oxygen. In summary, the clinician should be able to master different methods of lung separation and make him/her self familiar with the available devices.