Endobronchial Blocker

Created on Fri, 07/24/2015 - 18:31
Last updated on Thu, 08/27/2015 - 03:51

This rarely seen item was used as a visual prop in Question 24.1 from the second paper of 2012. The candidates weren't expected to recognise it- the examiners were more interested in its uses, advantages and disadvantages.

Indications for the use of the endobronchial blocker rather than DLT:

Cannot use the dual lumen tube:

  • nasal intubation
  • small patient
  • difficult intubation
  • patient with a tracheostomy
  • subglottic stenosis
  • thick and excessive secretions

Advantages of the endobronchial blocker

  • Can use the current normal ETT- no need to insert a DLT
  • Safer than the DLT in patients with a traumatic airway injury
  • Can provide selective lobar blockade of a specific lobe, rather than of the entire lung
  • Technically, simpler than DLT insertion

Disadvantages of the endobronchial blocker

The college suggest the following:

  • Do not allow suctioning of deflated lung due to small lumen
  • Requires ETT >7.5mm diameter.
  • Collapse of desired lung may be slow
  • Easily dislodged
  • Risk of perforation of bronchus or lung parenchyma
  • Difficult to block R upper lobe bronchus due to variable take-off.

To this I would add:

  • Surgery on a mainstem bronchus is impossible if the bronchus is blocked
  • Bronchoscopy of the blocked lung is impossible

 

References

Janossy, K. M., et al. "The effect of pilot balloon design on estimation of safe tracheal tube cuff pressure." Anaesthesia 65.8 (2010): 785-791.

Hoffman, Robert J., Vivek Parwani, and In-Hei Hahn. "Experienced emergency medicine physicians cannot safely inflate or estimate endotracheal tube cuff pressure using standard techniques." The American journal of emergency medicine 24.2 (2006): 139-143.

Parwani, Vivek, et al. "Practicing paramedics cannot generate or estimate safe endotracheal tube cuff pressure using standard techniques." Prehospital Emergency Care 11.3 (2007): 307-311.