Lecture on Double Lumen Tube in Lung Surgery

Purpose

• Objective: Ventilate the non-operative lung while leaving the operative lung down during lung surgery.
• Solution: Use of a double lumen tube.

Structure of Double Lumen Tube

• Two Ventilation Lumens:
  • Bronchiolumen:
    • Sits in a bronchus.
    • Has a blue cuff.
    • Ventilates the lung via the bronchus.
  • Tracheolumen:
    • Sits in the trachea.
    • Has a clear cuff.
    • Ventilates the lung via the trachea.

Types of Double Lumen Tubes

• Left Double Lumen Tube:
  • Commonly used.
  • Bronchiolumen designed for left main stem bronchus.
  • Ventilates left lung through bronchiolumen and right lung through tracheolumen.
  • Not suitable for right main stem due to difficulty ventilating the right upper lobe.
• Right Double Lumen Tube:
  • Used in specific cases like left lung transplant or left main stem mass.
  • Includes an extra ventilation port for the right upper lobe.

Materials Needed for Placement

• Double Lumen Tube itself.
• Specialized Adapter: Allows ventilation of both lungs simultaneously.
  • Includes caps for atmospheric exposure and passage for tools like fiber optic bronchoscopes and suction catheters.
• Large Hemostat: Used to isolate a lung.
• Stylet: Helps in placing the tube; always goes through bronchiolumen.

Procedure for Lung Isolation

• Clamp the double lumen tube proximal to the cap to open the lung to atmospheric air, allowing deflation.
• Suction Catheter Usage:
  • Apply initially to aid deflation.
  • Avoid prolonged suction to prevent atelectasis.
• Rapid Deflation Technique:
  • Disconnect the connector instead of opening the cap to expedite lung deflation.
  • Direct application of suction to connector can further speed up the process.

Precautions

• Avoid leaving suction connected to the lung for extended periods to prevent complications such as atelectasis.