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Updated: Mar 16, 2026
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Selective lung intubation during paediatric thoracic surgeries
Insights
Selective lung intubation using Univent or double-lumen tubes (DLT) in children undergoing thoracic surgery presents challenges. While improving surgical conditions, these methods have associated complications requiring careful consideration.
Area of Science:
- Pediatric Anesthesiology
- Thoracic Surgery
- Respiratory Management
Background:
- Selective lung intubation is crucial for pediatric thoracotomy and thoracoscopy.
- Current practices utilize Univent tubes for younger children and double-lumen tubes (DLT) for older children.
- Alternative methods involve regular endotracheal intubation with surgical retraction.
Purpose of the Study:
- To analyze the outcomes and complications of selective intubation methods in pediatric thoracic surgery.
- To evaluate the effectiveness of Univent tubes and DLT in pediatric patients.
- To assess the impact of selective intubation on surgical conditions.
Main Methods:
- Retrospective analysis of 860 thoracic surgeries.
- Focus on 491 cases involving selective intubation (Univent and DLT).
- Documentation of device-specific complications and insertion failures.
Main Results:
- Univent tube complications: obturating balloon dislocation (29.8%) and perforation (5.2%).
- DLT insertion challenges: failure to fit (20.6% required reinsertion) and inability to insert (1.8%).
- Standard use of selective intubation in children over two years improved surgical conditions.
Conclusions:
- Both Univent tubes and DLT are associated with significant intraoperative complications in pediatric patients.
- Despite complications, selective intubation methods, particularly in older children, enhance surgical intervention conditions.
- Further research may be needed to optimize device selection and minimize adverse events in pediatric thoracic surgery.
Abstract:
Selective lung intubation is a necessary prerequisite for the completion of most interventions comprising thoracotomy and thoracoscopy. In paediatric care, our site uses Univent tubes for children up to the age of three years and double-lumen tubes (DLT) for children from 6-8 years of age. In younger children, we usually use regular endotracheal intubation, with the lung being held in the hemithorax position being operated on using a surgical retractor. The article presents the analysis of 860 thoracic surgeries, of which 491 comprised selective intubation (Univent 57 cases, DLT 434 cases). The use of the aforementioned devices is connected with certain complications. Univent tube can be connected with intraoperative dislocation of the obturating balloon (29.8%) and balloon perforation (5.2%). DLT insertion may be connected with failure of tube fitting. In 84 cases we had to repeat DLT insertion (20.6%). In 8 cases we were not able to insert DLT at all (1.8%). Standard use of selective intubation methods in paediatric patients from two years of age improved the conditions for surgical interventions (Tab. 2, Fig. 2, Ref. 19).
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