One Lung Ventilation (OLV) is already challenging in adult patients. In children, this challenge is even greater. Limited resources, oversized sizes, and a faster respiratory response in children increase the risks. In this blog, I will discuss an OLV method using a 5 French (±1.65 mm) pediatric endobronchial blocker with an angled distal end.
What do you need?
- ET-tube 4.5, 5 or 5.5
- Fiberscope 2.2 or 2.8 mm
- Endobronchial blocker 5 fr (catheter + Y-piece)
- Lubricating spray
Preparation
Check the sizing of the bronchoscope in combination with the blocker in the tube. Lubricate the endobronchial blocker and fiberscope for smooth guidance through the tube. Measure when the blocker reaches the tip of the tube. Also, slightly loosen the fixation knob on the Y-piece of the blocker. Inflate the blocker balloon and check it for leaks. Also, check how many milliliters of air are needed for the expected size of the bronchus.
Intubation
This One Lung Ventilation method uses a standard endotracheal tube. Do not place the tube too deep, as this makes maneuvering the blocker more difficult.
Positioning endobronchial blocker
Once the tube is in the correct position, the blocker can be inserted. Advance the blocker, connect the Y-piece of the blocker to the tube, and connect the ventilation tube to the Y-piece.
Insert the blocker into the tube to the measured point. Advance the bronchoscope to just behind the end of the blocker. Then advance the bronchoscope parallel to the blocker. Rotate the blocker to maneuver the angled end in the right direction.
Has the desired position been reached? Inflate the balloon with the intended amount of air and check whether the bronchus is properly sealed. If this is the case, the bronchoscope can be removed. Deflate the balloon again until the lung actually needs to be sealed off.
Collapsing the lung
The lung is collapsed by keeping the blocker balloon deflated as soon as the surgeon opens the pleura. The lung will then collapse. Once the lung has reached the desired size, inflate the balloon.
Draining the lung via the narrow lumen in the endobronchial blocker is not a correct method. The lumen is not intended for this and it takes a lot of time; the lumen will quickly become occluded.
Completing procedure
Once the intended lung can be ventilated again, you can deflate the balloon. The blocker can then be removed by pulling it back through the tube and immediately disconnecting the Y-piece.
This is an example procedure of how it can work with the pediatric endobronchial blocker. Another option for smaller children is to place the blocker next to the tube.
