single lung ventilation

[MARK FORREST]

Nice idea Rob,
This is one that I haven't seen, although working in a centre that does Major Head & Neck, Thoracic, trauma and teaches percutaneous tracheostomy to junior docs, you get to see most of the difficult complications in the trachea. As a result we have used several 'novel' methods, where tube change has not been ideal or for tracheal injuries and differential lung problems. These include:
 
-Use of an uncut microlaryngoscopy tube (MLT), passed alongside the standard COETT to isiolate the lung
-Use of two MLT tubes, passed beyond the damaged trachea
- Two MLTs (as above) with one lung on coventional ventilation and the other on an oscillator (seen jet vent used in similar fashion before)
- use of new generation of endobronchial blockers through the tube in the set or through a standard tube already in place
 
Just a few ideas to add to those 'back of the mind solutions' when things get difficult in ICU or resus room!!
Cheers
Mark F
UK
 
 


----- Original Message ----
From: Robert Smith <rfsmithmd at comcast.net>
To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org>
Sent: Tuesday, 1 August, 2006 5:15:44 PM
Subject: RE: single lung ventilation


Recently there was a pt. with a transmediastinal GSW. The esophagus was
injured, repaired and developed a leak so the pt. developed mediastinitis
and was quite ill. When his ET tube became dislodged he almost died. The
left lung was full of blood and crap and was not contributing in any useful
way. It was determined that he would benefit from R lung ventilation but
everyone was scared to change the tube after his recent near death
experience. So Rocky had a resident attach a large diameter tube to the
first one, and advance the whole thing into the R bronchus. It worked great.
I don't know if any of you have had a similar experience.

Rob Smith, M.D.

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