Bronchial blocker is a device that can isolate part of the bronchial tree at the lobar level
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
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
- 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.
- 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.