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Ann Thorac Surg 1994;58:892-894
© 1994 The Society of Thoracic Surgeons

Articles

Airway management during bilateral sequential lung transplantation for cystic fibrosis

Mark S. Soberman, MD, Erik J. Kraenzler, MD, Michael Licina, MD, Charles D. Fraser, Jr, MD, Thomas J. Kirby, MD*

Departments of Thoracic and Cardiovascular Surgery and Anesthesia, Cleveland Clinic Foundation, Cleveland, Ohio USA

Accepted for publication June 14, 1994.

* Address reprint requests to Dr Kirby, Department of Thoracic and Cardiovascular Surgery. Desk F-25, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195.

Bilateral sequential lung transplantation is now an accepted therapy for patients with end-stage cystic fibrosis. In our experience, the use of a standard double-lumen endotracheal tube to establish one-lung ventilation during bilateral lung transplantation has been associated with difficulty in clearing the airway of the thick, tenacious secretions characteristically seen in these patients. Intraoperatively, retained secretions have resulted in inadequate ventilation with subsequent hypercarbia, hypoxia, and the need for cardiopulmonary bypass support. We therefore changed our airway management to a single-lumen endotracheal tube combined with a bronchial blocker to establish one-lung ventilation during bilateral lung transplantation. The lumen of a single-lumen tube accommodates larger suction catheters and an adult bronchoscope, which has a larger suction port. We have used this technique in our last five transplantations, finding easier clearing of airway secretions along with markedly improved ventilation compared with management with a double-lumen tube. We recommend this technique of airway management when performing a bilateral single-lung transplantation for end-stage cystic fibrosis.






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