Review article

The Use of Bronchial Blockers for Providing One-Lung Ventilation

The Choice: Double-Lumen Tube Versus Bronchial Blocker

The relatively large lumens of a double-lumen tube (DLT) facilitate faster lung deflation. They also allow for the passage of a suction catheter, which could be used for suctioning or applying continuous positive airway pressure (CPAP). A DLT is indicated when there is bleeding or infection in one lung; this would best protect the unaffected lung from contamination, and allow for effective suctioning of the diseased lung. It is easier to apply CPAP to the deflated lung when using a DLT because

Early History of BBs

The use of a BB was first reported by Magill in 1936.⁶ This BB consisted of a rubber tube with an inflatable cuff at the distal end. A stylette in its lumen facilitated positioning, which was accomplished via a rigid bronchoscope. An endotracheal tube would then be placed in the trachea to allow ventilation of the contralateral lung.

In the past, a vascular embolectomy catheter such as the Fogarty catheter was commonly used for providing OLV. However, these catheters contain low-volume,

Pediatrics

Providing OLV can be particularly challenging in the pediatric population. DLTs can be used in adults and older children but cannot be placed in infants and young children; the smallest size available is 26F or 28F, depending on the manufacturer. One method commonly used in the past had been to advance an SLT into the contralateral mainstem bronchus. In a series of 15 children undergoing thoracotomy, a 7F Fogarty catheter was placed initially in the trachea and advanced until resistance was

Summary

The use of BBs as a means for providing OLV has grown. There are multiple choices of BB that are currently available and have been discussed in this review. The use of a BB can be especially advantageous in a patient with a difficult airway in whom a SLT can be used and then will not have to be changed. Whether a DLT or BB is chosen as the technique, it is important that the practitioner be familiar with the device.²² The ABCs of lung isolation that must be adhered to have been described by