Bronchial blocker
OVERVIEW
Bronchial blocker is a device that can isolate part of the bronchial tree at the lobar level
USE
To avoid contamination of a non-diseased lung
- Infection (e.g. unilateral pulmonary abscess)
- Massive pulmonary haemorrhage
- Unilateral pulmonary lavage (pulmonary alveolar proteinosis)
Control of distribution of ventilation
- Bronchopleural fistula
- Giant unilateral lung cyst or bulla
- Tracheobronchial tree disruption /Major airway trauma
- Severe hypoxaemia due to unilateral lung disease
During surgical procedures
- Pneumonectomy, lobectomy
- Oesophageal resection
- Lung transplant
- Thoracic aneurysm surgery
- Thoracic spine surgery
DESCRIPTION
Multiple different types:
- Magill’s original bronchial blocker was a tube with an inflatable cuff at its distal end that was advanced alongside a single-lumen endotracheal tube.
- Fogarty vascular embolectomy catheter
- Wiruthan bronchial blocker
- single-lumen endotracheal tube with an enclosed bronchial blocker (Torque Control Blocker Univent®)
- wire-guided endobronchial blocker (Arndt)
METHOD OF USE
- inserted down ETT >7.5 cm ID
- bronchoscope used to place blocker at chosen location
- precise technique varies with type of blocker used
FURTHER INFORMATION
Advantages
- Can be used in patients through existing endotracheal tube (oral or nasal)
- without requirement to change to a double-lumen tube or back to a single lumen tube after. Therefore useful in patients with difficult airway, cervical spine injury, etc.
- Can be used in patients with major airway trauma or distorted trachoebronchial anatomy more safely than DLT
- Can provide selective lobar blockade of a specific lobe- in cases of haemorrhage, air leak, infection in one lobe, thereby allowing ventilation of more lung units.
Disadvantages
- Do not allow suctioning of deflated lung due to small lumen
- Requires ETT >7.5mm diameter
- Collapse of desired lung may be slow
- Easily dislodged
- Risk of perforation of bronchus or lung parenchyma
- Difficult to block R upper lobe bronchus due to variable take-off.
References and Links
- Campos JH. An update on bronchial blockers during lung separation techniques in adults. Anesth Analg. 2003 Nov;97(5):1266-74. Review. Erratum in: Anesth Analg. 2004 Jan;98(1):131. PMID: 14570636.
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
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