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[Bronchial blocking with a balloon wedge pressure Catheter in a small infant]
Akiko Hashimoto Satoi1, Kohei Murao, Kozue Kubo
1Department of Anesthesiology, Kansai Medical University, Moriguchi 570-8506.
Insights
A novel technique using a balloon wedge pressure catheter enabled one-lung ventilation in a 2kg infant. This method successfully isolated the left lung for surgery, proving safe and effective in pediatric patients.
Area of Science:
- Pediatric Anesthesiology
- Thoracic Surgery
- Respiratory Physiology
Background:
- One-lung ventilation (OLV) is increasingly required in pediatric patients.
- Standard double-lumen endotracheal tubes are often unsuitable for pediatric airways due to narrow tracheas.
- Alternative methods for lung isolation are needed for pediatric thoracic surgery.
Observation:
- A 2kg infant with severe chronic lung disease required mechanical ventilation for a left lung lower lobectomy.
- A balloon wedge pressure catheter was selected for left main bronchus occlusion due to its central lumen and suction capability.
- The catheter's softness necessitated a novel insertion technique using a needle-catheter assembly and fiberoptic bronchoscopy.
Findings:
- Successful one-lung ventilation was achieved in the infant using the modified balloon wedge pressure catheter technique.
- The technique allowed for effective isolation of the left lung during the lobectomy procedure.
- The infant's operative and postoperative course was uneventful, indicating the safety and efficacy of the method.
Implications:
- This case demonstrates a viable alternative for achieving one-lung ventilation in neonates and small infants.
- The described technique offers a potential solution for lung isolation when standard equipment is not feasible.
- Further research into specialized pediatric airway management techniques is warranted.
Abstract:
The need for one-lung ventilation has been increasing even in pediatric patients. However, the trachea is so narrow in pediatric patients that ordinary double-lumen tubes can not be used and there have been many reports on devices or measures to block one lung. We report our experience with a female infant weighing 2 kg who had severe chronic lung disease under mechanical ventilation, and underwent left lung lower lobectomy with one-lung ventilation technique. We chose a balloon wedge pressure catheter to block the left main bronchus, because it has a central lumen through which a guide wire can be passed and sucking is available. The infant was in need of continuous ventilation and the catheter was too soft to be inserted directly. We first inserted an 18G catheter of a needle-catheter assemble outside the tracheal tube through which a guide wire was inserted into the left main bronchus with the aid of direct vision of a 2-mm fiberoptic bronchoscope through the tracheal tube, and then inserted the balloon wedge pressure catheter placing it in an appropriate position. One-lung ventilation was successfully achieved and the operative and postoperative course was uneventful.
