Managing One-Lung Ventilation in Tracheostomized Patients: A 6-Year Retrospective Analysis

Abstract

Background To ensure safe and optimal surgical conditions in thoracic surgery, one-lung ventilation is crucial. Various techniques exist to achieve one-lung ventilation. Tracheotomized patients who require one-lung ventilation represent a unique and rare subgroup that demands specialized knowledge and skills. The very limited literature has discussed alternative methods, no randomized controlled trials have addressed this issue yet.

Methods We performed a retrospective analysis of patients who underwent one-lung ventilation in the Department of Thoracic Surgery of a German University Hospital between 2016 and 2021. The study assessed patient demographics, airway management techniques, ventilation parameters, and adverse events.

Results In 3,197 anesthesia procedures during the observation period, 152 patients had an existing tracheostomy, of which 56 required one-lung ventilation. Among others in 42 cases, a tracheostomy tube was combined with a bronchial blocker, and in 10 cases, a double-lumen tracheostomy tube was used. There were no severe complications. Intraoperative dislocations that required repositioning of the device occurred in six patients (13.3%) with bronchial blockers and one patient with double-lumen tracheostomy tube (10%).

Conclusion The management of one-lung ventilation in tracheotomized patients presents unique challenges. While double-lumen tracheostomy tubes have specific advantages, we recommend considering their use carefully. For most tracheotomized patients, bronchial blockers in conjunction with a tracheostomy tube are used, which offers safety and practicality, irrespective of the tracheostomy's age or type. Further research and randomized controlled trials are warranted to establish best practices for one-lung ventilation in this unique patient population.

Keywords

airway - anesthesia - practice - guidelines - trachea - ventilation

Publication History

Received: 06 January 2024

Accepted: 27 February 2024

Article published online:
16 April 2024

• References

• 1 Huybrechts I, Tuna T, Szegedi LL. Lung separation in adult thoracic anesthesia. Saudi J Anaesth 2021; 15 (03) 272-279
• 2 Kumar N, Mitchell J, Siemens A. et al. Left-sided double-lumen tube vs EZ-Blocker for one-lung ventilation in thoracic surgery: a systematic review and meta-analysis. Semin Cardiothorac Vasc Anesth 2023; 27 (03) 171-180
• 3 Lu Y, Dai W, Zong Z. et al. Bronchial blocker versus left double-lumen endotracheal tube for one-lung ventilation in right video-assisted thoracoscopic surgery. J Cardiothorac Vasc Anesth 2018; 32 (01) 297-301
• 4 Uzuki M, Kanaya N, Mizuguchi A. et al. One-lung ventilation using a new bronchial blocker in a patient with tracheostomy stoma. Anesth Analg 2003; 96 (05) 1538-1539
• 5 Sekhon AP, Nishiguchi BK, Maldonado Y, Harter RL. Extraluminal placement of an arndt bronchial blocker through a tracheal stoma. J Cardiothorac Vasc Anesth 2016; 30 (02) e14-e15
• 6 Garg R, Kumari A, Gupta N, Kumar V. One-lung ventilation for lung lobectomy using endobronchial blocker through adjustable silicon hyperflex tracheostomy tube in postlaryngectomy patient. A A Case Rep 2016; 7 (06) 132-134
• 7 Campos JH, Musselman ED, Hanada S, Ueda K. Lung isolation techniques in patients with early-stage or long-term tracheostomy: a case series report of 70 cases and recommendations. J Cardiothorac Vasc Anesth 2019; 33 (02) 433-439
• 8 Shiono S. The role of pulmonary metastasectomy for pulmonary metastasis from head and neck cancer. J Thorac Dis 2021; 13 (04) 2643-2648
• 9 Wolfram A, Whitmore J, Haines D, Grell R. Double lumen endobronchial tube placement for lung separation via a tracheostomy stoma in a patient status-post laryngectomy. Cureus 2023; 15 (06) e39858
• 10 Palaczynski P, Misiolek H, Szarpak L. et al. Systematic review and meta-analysis of efficiency and safety of double-lumen tube and bronchial blocker for one-lung ventilation. J Clin Med 2023; 12 (05) 1877
• 11 Knoll H, Ziegeler S, Schreiber JU. et al. Airway injuries after one-lung ventilation: a comparison between double-lumen tube and endobronchial blocker: a randomized, prospective, controlled trial. Anesthesiology 2006; 105 (03) 471-477
• 12 Defosse J, Schieren M, Böhmer A. et al. [A Germany-wide survey on anaesthesia in thoracic surgery]. Anaesthesist 2016; 65 (06) 449-457