Question 27.2

Created on Sat, 05/16/2015 - 19:35
Last updated on Fri, 04/28/2017 - 18:31
Pass rate: 38%
Highest mark: 7.0

Other SAQs in this paper

Other SAQs on this topic

a) What is the device depicted below?

DLT

b) List the indications for its use in the ICU

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College Answer

a) What is the device depicted below?
Double lumen endobronchial tube (right sided)

b) List the indications for its use in the ICU
Anatomical or physiological lung separation
Massive haemoptysis from unilateral lesion
Whole lung lavage eg alveolar proteinosis
Copious infected secretions with risk of soiling unaffected lung eg bronchiectasis, lung abscess
Unilateral parenchymal injury
Aspiration
Pulmonary contusion
Pneumonia
Unilateral pulmonary oedema
Single lung transplant
Bronchopleural fistula
Unilateral bronchospasm

Discussion

Yes, that's a right sided dual lumen tube. You can tell because the blue cuff is eccentric - its unusual shape is owed to need to ventilate the right upper lobe bronchus. A normal-shaped tube would block that lobe, with predictably unhealthy consequences.

The indications for the use of the dual lumen tube are discussed in greater detail in the dual-lumen endotracheal tube chapter from the mechanical ventilation section.  I will not duplicate that content, and I will merely regurgitate the college answer in a slightly adjusted form.

  • Prevention of cross-contamination of one lung by the other, eg. in the following cases:
    • Infection (e.g. unilateral pulmonary abscess)
    • Massive pulmonary haemorrhage
  • Enable the ventilation of each lung with a different ventilation setting in settings where the each hemithorax is wildly different from the other, for example:
    • Severe chest injury
    • Bronchopleural fistula
    • Open chest (eg. mid thoracic surgery)
    • Giant unilateral lung cyst or bulla
  • Bypass a damaged section of the airway
    • Tracheobronchial tree disruption /Major airway trauma
  • Permit the lavage of each lung independently - pulmonary alveolar proteinosis is frequently mentioned as an indication, and I suppose if one finds oneself bringing it up during a viva, one should then be prepared to discuss what it is.
 

References

A detailed autopsy of these devices can be found in the 5th edition of "Understanding Anaesthesia Equipment" By Dorsch and Dorsch. Section III, chapter 20.
This chapter seems to be available for free.

Trapnell, Bruce C., Jeffrey A. Whitsett, and Koh Nakata. "Pulmonary alveolar proteinosis." New England Journal of Medicine 349.26 (2003): 2527-2539.