Selective left bronchial intubation and left-lung isolation in infants and toddlers: analysis of a new technique.

OBJECTIVES

The purpose of this study was to analyze and compare a new technique for left bronchial intubation and left-lung isolation in infants and toddlers without the help of bronchoscopes.

METHODS

In this prospective, unique comparative study, 3 different techniques for left mainstem bronchus intubation and left-lung isolation using a Fogarty catheter as a bronchial blocker were conducted in 11 children under age 4 who required left-lung isolation for left-lung surgery. A new technique for Fogarty catheter insertion and balloon inflation for proper positioning and avoiding displacement during lung handling was used. The first technique was a blind introduction to the left bronchus of the endotracheal tube (ETT) with the head turned to the right and the tube turned to the left at 180 degrees . The second one was to introduce the preshaped Fogarty catheter to the left bronchus. The third one was to intubate the left bronchus using the new technique of a preshaped ETT.

RESULTS

No left bronchial intubation could be achieved with the first technique. Left bronchial intubation and isolation were achieved in 2 of 11 by the second technique and 10 of 11 using the third technique. No bulb displacement occurred in any of these during lung handling.

CONCLUSION

The new technique of left bronchial intubation with a preshaped endotracheal tube was simple, safe, and easily accomplished. A Fogarty catheter can be positioned properly without the aid of a smaller bronchoscope once the left bronchus is intubated. Balloon displacement can be avoided completely if the left lung is collapsed properly and completely before the final balloon inflation.