Breathing Skills 3:
Endobronchial Tube
Traumatic rupture of a major bronchus is a severe injury. It results in tension pneumothorax. Treatment of the tension pneumothorax with a chest tube results in a large air leak. This air leak may be so large as to make ventilation difficult or impossible. The solution to this problem would be to use an endobronchial tube to make it possible to ventilate the lungs separately. At least one lung can then be ventilated.
- Select a LEFT endobronchial tube. A right endobronchial tube is much more difficult to use and probably less effective. The tube comes with a stiff obturator that keeps it straight during intubation.
- Once the tube has been inserted past the vocal cords, pull out the obturator. The tube will now want to curve to the left as it is advanced down the trachea. Advance it until it meets resistance. The tip is now plugging the left main stem bronchus. Pull it back slightly and gently inflate the distal cuff. Inflate the tracheal cuff.
- Try ventilating each lung separately while watching for air leak in the chest suction apparatus. A chest x-ray may help in placing the balloons in the optimum position.
Reference
- Shimazu T, Sugimoto H, Nishide K, Terai C, et al. Tracheobronchial rupture caused by blunt chest trauma: acute respiratory management. Am J Emerg Med. 1988;6(5):427-434.