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Wed Aug 2 02:11:55 BST 2006

I don't understand the problem.
Esophagus perforated and mediastinite, Ok.
Why was the ET tube dislodge ???? And he was intubated with a single tube or
with a double lumen or other ?????

We had a similar case years ago, but we intubate with a RobertShaw Left and
we have done double ventilation with two ventilators ( SERVO 900C - that was
what we have) without syncronization because we has not the cable that
syncronize the two ventilators.
In some cases of fistula bronchopleural , that can not be repared
surgically, or lung abcesses, we intubate with double lumen with or without
double ventilation.

The problem of intubation, difficult intubation is another thing. I have
done changes of traqueal tube in difficult airway with a guidewire ( Central
catheter...) or with a nasogastric tube inside the first tube, after
ventilation with FiO2 =1,0 and after keep out this one and introduce over
the guidewire or the nasogastric tube the other.

Another thing is the time of no ventilation and hypoxemia , in a patient
that can not tolerate any time without ventilation, but I think time to
change a traqueal tube in normal conditions ( not with a difficult airway)
is not a great problem.

In the case, you tell us, why not go with the first tube in to the right
bronchus ????

Rita Perez
ritaperez at netcabo.pt
Chefe de Serviço de Anestesiologia
Hospital S. Francisco Xavier
Centro Hospitalar Lisboa Ocidental
Portugal

-----Mensagem original-----
De: Robert Smith [mailto:rfsmithmd at comcast.net] 
Enviada: terça-feira, 1 de Agosto de 2006 17:16
Para: 'Trauma &amp; Critical Care mailing list'
Assunto: 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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