Double Lumen Endotracheal Tube

Double-lumen endotracheal tube for one-lung

ventilation through a fresh tracheostomy

stoma: A case report

Lana Leinbach Yaney, CRNA, MS, BSN

South Weymouth, Massachusetts

For one-lung ventilation in many surgical cases, doublelumen endotracheal tubes are the first-line choice for airway

management. For most cases, double-lumen endotracheal

tubes are faster, easier to place, cheaper, and less prone to

malposition than today’s bronchial blocker devices.

This report describes an elective tracheostomy and the

use of a double-lumen endotracheal tube directly through

the fresh stoma site for a 55-year-old man with a known difficult airway who had undergone a left-sided radical neck

dissection and postoperative radiation 10 years earlier. The

11-hour operation, in supine and lateral positions, occurred

uneventfully. This report documents one-lung ventilation of

a 4-hour duration using a double-lumen endotracheal tube

directly through a fresh tracheostomy site without supple-

T

his report involves a unique case of successful one-lung ventilation of a 4-hour duration

using a conventional double-lumen endotracheal tube (DL-ETT) electively placed

directly through a fresh stoma site in a

patient with abnormal upper airway anatomy. This

type of airway management is unusual, and there is

limited information in the anesthesia literature to support its use. Other alternative airways for patients

with a known difficult intubation and the requirement

of one-lung ventilation for maximum surgical exposure are described. The Univent (Vitaid, Ltd, Toronto,

Ontario, Canada) and Arndt blockers (Cook Medical

Inc, Bloomington, Indiana) have been used in patients

with existing tracheostomies who require one-lung

ventilation. These bronchial blockers will be explored

as potential options for optimal airway management

as related to this particular case.

Case summary

A 55-year-old man, ASA physical status III, with a

known history of difficult airway...