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Tue Aug 1 18:45:41 BST 2006

You can do that. It is better to use a "double lumen" tube as the RUL bronchus often branches off the R mainstem a very short distance  from the carina.  Advancing a regular tube down the R side will often occlude the RUL.  You can also bronch the left side free of blood and debris with a double lumen.  It can be difficult given that you have to use a pedi bronch and the small size makes it difficult to suction.  If you have no other choice you did the right thing. 

Rebecca Wolfer, MD, FACS, FCCP
Associate Professor, Marshall University School of Medicine
Dept of Surgery
Director Thoracic Surgery
Director, Surgical Critical Care Cabell Huntington Hospital
Director, Trauma Cabell Huntington Hospital

-----Original Message-----
From: rfsmithmd at comcast.net
To: trauma-list at trauma.org
Sent: Tue, 1 Aug 2006 12:15 PM
Subject: RE: single lung ventilation

Recently there was a pt. with a transmediastinal GSW. The esophagus was
injured, repaired and developed a leak so the pt. developed mediastinitis
and was quite ill. When his ET tube became dislodged he almost died. The
left lung was full of blood and crap and was not contributing in any useful
way. It was determined that he would benefit from R lung ventilation but
everyone was scared to change the tube after his recent near death
experience. So Rocky had a resident attach a large diameter tube to the
first one, and advance the whole thing into the R bronchus. It worked great.
I don't know if any of you have had a similar experience.

Rob Smith, M.D.

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single lung ventilation