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.

CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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