A novel maneuver to blindly position bronchial blockers

The use of a fiberoptic bronchoscope is fundamental to the positioning of bronchial blockers. However, a fiberoptic bronchoscope could be unavailable. We tried to devise a blind method to locate the blocker without help of a fiberoptic bronchoscope.

In 56 thoracic surgical patients requiring one-lung ventilation, a Uniblocker® was inserted into the endotracheal tube and advanced until the blocker balloon just protruded from the endotracheal tube tip. With inflation of the balloon, peak inspiratory pressure increased abruptly with disappearance of expiratory tidal volume. The blocker was advanced with its tip directed to one side until peak inspiratory pressure abruptly dropped and expiratory tidal volume re-appeared. Thereafter, the blocker was advanced 3 cm further with the cuff deflated. Using a fiberoptic bronchoscope, the position of the blocker was checked after re-inflation of the cuff. The entire procedure was repeated on the other side.

Acceptable blocker placements were achieved on 48 of 56 (85.7%) right attempts; the right upper bronchus was not blocked in 5 cases and blocker positions were too shallow in 3. Only 33 of 56 (58.9%) left attempts were acceptable in that blockers could not be advanced into the left bronchus in 19 and were positioned too shallow in 4.

This novel technique to blindly position bronchial blockers could be almost successful in isolating the right lung. However, isolation of the left lung was frequently unsuccessful in spite of several attempts.