Page 175 - Clinical Application of Mechanical Ventilation

Special Airways for Ventilation 141

Tracheal Pilot Balloon Bronchial Pilot Balloon

Tracheal Tube Bronchial Tube

Tracheal Cuff

Bronchial Cuff

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Figure 5-12 A left-sided double-lumen endobronchial tube (DLT) in working position with
the tracheal and bronchial cuffs instead.

The left-sided tube is more commonly used than the right-sided tube. This is be-
cause precise placement of the right-sided tube is more difficult, as the right upper
lobe bronchus is only about 2 cm from the carina of an adult. Should the distal end
of the right-sided tube pass the right upper lobe bronchus, there would be no ven-
tilation to the right upper lobe. Figure 5-12 shows a left-sided DLT in its working
position with both cuffs inflated.

Indications

Independent lung There are three main uses of DLTs. They are used to provide independent lung
ventilation is done via a DLT
to facilitate lung isolation, ventilation where isolation of the lungs is desirable in order to prevent lung-to-
surgical procedure, and bron- lung spillage of blood or pus. They are also used to provide one-lung ventilation
chopleural/bronchocutaneous
fistulas. so that the nonventilated lung may undergo surgical procedure on the thoracic
structures with minimal movement. In disease conditions such as bronchopleural

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