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Mon, 4 Mar 2002 01:24:11 -0000

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For emergency surgery we always try and manage with a standard tube. =
However, if there is gross bleeding/contamination into the airway or =
surgery involves the proximal bronchi then I will go for a D. lumen.

If the surgeon simply needs the lung down or I need short period of lung =
isolation, then I will use the new generation of blockers such as the =
ARNDT endobronchial blocker (Had a few problems with herniation when =
with first generation where the RUL comes off close to carina, but new =
model better.)

As for on ITU, we have been using independent lung ventilation less and =
less in recent years. We limit it to single contaminated lungs, isolated =
lung injures and very large fistula or damage to bronchi where the =
surgeons do not wish to operate.
Ventilation strategies used to be one lung conventional and one lung jet =
ventilation. More recently we have been oscillating the affected lung, =
but this can make matters worse, if there is a big leak, as the mean =
ventilatory pressures are often somewhat higher than conventional. We do =
not use gas insufflation.
Hope that this very brief summary is of help
Regards
Mark F
  ----- Original Message -----=20
  From: Keith D. Lamb=20
  To: trauma-list@trauma.org ; Respiratory Care Professionals World =
Forum ; ccm-l@list.pitt.edu=20
  Sent: Sunday, March 03, 2002 3:58 PM
  Subject: (no subject)

  How often are folks intubating with double lumen endotracheal tubes =
and for what indications? I don't meant intra-op for thoracic =
surgery...but pre-op...or post-op...for specific injury/pathology and to =
facilitate independent lung ventilation.=20

  For what injury/pathology are you seeing this performed most often? =
Example parenchymal injury/pathology or bronchus injury.....fistula etc. =

  When your patient IS intubated in this fashion and each lung is being =
ventilated independently.....what kind of strategy do you employ =
regarding ventilator modes. Do you synchronize or not. Do you attempt to =
use just a little bit of CPAP with the injured side...or some other =
strategy. Do you conventionally ventilate the healthy lung and "jet" or =
"oscillate" the injured lung? Does tracheal gas insufflation have a role =
in this setting?  Any thoughts?

  keith

  Keith D. Lamb RCP, RRT
  Christiana Care Hospital
  Newark, Delaware

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<DIV><FONT face=3DArial size=3D2>For emergency surgery we always try and =
manage with=20
a standard tube. However, if there is gross bleeding/contamination into =
the=20
airway or surgery involves the proximal bronchi then I will go for a D.=20
lumen.</FONT></DIV>
<DIV><FONT face=3DArial size=3D2></FONT>&nbsp;</DIV>
<DIV><FONT face=3DArial size=3D2>If the surgeon simply needs the lung =
down or I need=20
short period of lung isolation, then I will use the new generation of =
blockers=20
such as the ARNDT endobronchial blocker (Had a few problems with =
herniation when=20
with&nbsp;first generation where the RUL comes off close to carina, but =
new=20
model better.)</FONT></DIV>
<DIV><FONT face=3DArial size=3D2></FONT>&nbsp;</DIV>
<DIV><FONT face=3DArial size=3D2>As for on ITU, we have been using =
independent lung=20
ventilation less and less in recent years. We limit it to single =
contaminated=20
lungs, isolated lung injures and very large fistula or damage to bronchi =
where=20
the surgeons do not wish to operate.</FONT></DIV>
<DIV><FONT face=3DArial size=3D2>Ventilation strategies used to be one =
lung=20
conventional and one lung jet ventilation. More recently we have been=20
oscillating the affected lung, but this can make matters worse, if there =
is a=20
big leak,&nbsp;as the mean ventilatory pressures are often somewhat =
higher than=20
conventional. We do not use gas insufflation.</FONT></DIV>
<DIV><FONT face=3DArial size=3D2>Hope that this very brief summary is of =

help</FONT></DIV>
<DIV><FONT face=3DArial size=3D2>Regards</FONT></DIV>
<DIV><FONT face=3DArial size=3D2>Mark F</FONT></DIV>
<BLOCKQUOTE dir=3Dltr=20
style=3D"PADDING-RIGHT: 0px; PADDING-LEFT: 5px; MARGIN-LEFT: 5px; =
BORDER-LEFT: #000000 2px solid; MARGIN-RIGHT: 0px">
  <DIV style=3D"FONT: 10pt arial">----- Original Message ----- </DIV>
  <DIV=20
  style=3D"BACKGROUND: #e4e4e4; FONT: 10pt arial; font-color: =
black"><B>From:</B>=20
  <A title=3Dkdlamb@prodigy.net href=3D"mailto:kdlamb@prodigy.net">Keith =
D. Lamb</A>=20
  </DIV>
  <DIV style=3D"FONT: 10pt arial"><B>To:</B> <A =
title=3Dtrauma-list@trauma.org=20
  href=3D"mailto:trauma-list@trauma.org">trauma-list@trauma.org</A> ; <A =

  title=3DRC_WORLD@LISTSERV.IUPUI.EDU=20
  href=3D"mailto:RC_WORLD@LISTSERV.IUPUI.EDU">Respiratory Care =
Professionals World=20
  Forum</A> ; <A title=3Dccm-l@list.pitt.edu=20
  href=3D"mailto:ccm-l@list.pitt.edu">ccm-l@list.pitt.edu</A> </DIV>
  <DIV style=3D"FONT: 10pt arial"><B>Sent:</B> Sunday, March 03, 2002 =
3:58=20
PM</DIV>
  <DIV style=3D"FONT: 10pt arial"><B>Subject:</B> (no subject)</DIV>
  <DIV><BR></DIV>
  <DIV><FONT face=3DArial size=3D2>How often are folks intubating with =
double lumen=20
  endotracheal tubes and for what indications? I don't meant intra-op =
for=20
  thoracic surgery...but pre-op...or post-op...for specific =
injury/pathology and=20
  to facilitate independent lung ventilation. </FONT></DIV>
  <DIV><FONT face=3DArial size=3D2></FONT>&nbsp;</DIV>
  <DIV><FONT face=3DArial size=3D2>For what injury/pathology are you =
seeing this=20
  performed most often? Example parenchymal injury/pathology or bronchus =

  injury.....fistula etc. </FONT></DIV>
  <DIV><FONT face=3DArial size=3D2></FONT>&nbsp;</DIV>
  <DIV><FONT face=3DArial size=3D2>When your patient IS intubated in =
this fashion=20
  and each lung is being ventilated independently.....what kind of =
strategy do=20
  you employ regarding ventilator modes. Do you synchronize or not. Do =
you=20
  attempt to use just a little bit of CPAP with the injured side...or =
some other=20
  strategy. Do you conventionally ventilate the healthy lung and "jet" =
or=20
  "oscillate" the injured lung?&nbsp;Does&nbsp;tracheal gas insufflation =
have a=20
  role in this setting? &nbsp;Any thoughts?</FONT></DIV>
  <DIV><FONT face=3DArial size=3D2></FONT>&nbsp;</DIV>
  <DIV><FONT face=3DArial size=3D2>keith</FONT></DIV>
  <DIV><FONT face=3DArial size=3D2></FONT>&nbsp;</DIV>
  <DIV><FONT face=3DArial size=3D2>Keith D. Lamb RCP, RRT<BR>Christiana =
Care=20
  Hospital<BR>Newark, Delaware</FONT></DIV></BLOCKQUOTE></BODY></HTML>

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