An improved method for introducing an endobronchial blocker

T HERE ARE numerous indications for onelung ventilation. These include protection of one lung from hemorrhage, an abscess or cyst in the opposite lung, independent lung ventilation with problems such as a bronchopleural fistula, and, most commonly, thoracic surgery, where the collapse of the lung on the operative side provides an improved surgical field. Relative surgical indications include total esophagectomy, aortic arch surgery, and resection of one or more lobes of the lung itself. Endobronchial blockers, which permit isolation of one lung from the other, were first developed and introduced nearly 50 years ago.lV2 Their use was almost abandoned with the development of the double-lumen endotracheal tube. However, double-lumen tubes can cause problems. These include trauma, inadequate ventilation resulting from malposition, blockage or kinking, and difficulty in placement. The authors report a case in which a unique method for inserting an endobronchial blocker was successfully used in a patient who was not a candidate for placement of a double-lumen endotracheal tube because of a prior tracheostomy.