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Eur J Cardiothorac Surg 2005;28:169-171
© 2005 Elsevier Science NL

How-to-do-it

Use of a modified endobronchial tube for mechanical ventilation of patients with bronchopleural fistula

^a Thoracic Surgery, Second University of Naples, Naples, Italy
^b Anaesthesiology, Second University of Naples, Naples, Italy

Received 28 February 2005; accepted 29 March 2005.

^* Corresponding author. Address: Chirugia Toracica, Seconda Università di Napoli, Piazza Miraglia, 2, 80138 Napoli, Italy. Tel.: +39 081 566 5228; fax: +39 081 566 5230. (Email: mario.santini{at}unina2.it).

Mechanical ventilation in patients with bronchopleural fistula after lung resection is a major problem, as it causes increase of the air-leak, complicates the healing process and makes residual lung tissue ventilation difficult. We present two cases in which the use of a modified double lumen endobronchial tube improved ventilation and eliminated the fistula air-leak. We used a right-sided double lumen sher-i-bronch ^© tube (Sheridan Catheter Corp., USA). This method, by blocking the airflow through the fistula, may facilitate the expansion of the residual lung parenchyma. In both the patients treated with this technique, we obtained a good expansion of the residual parenchyma. Despite the procedure, the first patient died of septic shock; in the second patient, we achieved improvement of the respiratory function, the weaning from the mechanical ventilation, and thereafter, the healing of the fistula. The use of a modified double lumen sher-i-bronch ^© tube in mechanically ventilated patients with post-resection bronchopleural fistula allows the anaesthesiologist to suction separately the two lungs and to ventilate adequately the remaining lung tissue, thus obtaining the lung reexpansion and the consequent reduction of the residual pleural space, and facilitating the healing of the fistula.

Key Words: Bronchopleural fistula • Mechanical ventilation • Endobronchial tubes