Recent Advances in Lung Isolation Techniques

13 May 2019, 17:00 – 19:00 CET

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EACTA Educational Committee in collaboration with the Thoracic Anaesthesia Committee
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Chaired by:
Prof. Laszlo Szegedi
Charleroi, Belgium, Chair of Thoracic Anaesthesia Committee

CME CREDITS:

The Recent advances in Lung Isolation Tecniques, Rome, Italy, 13/05/2019-13/05/2019 has been accredited by the European Accreditation Council for Continuing Medical Education (EACCME®) with 2 European CME credits (ECMEC®s). Each medical specialist should claim only those hours of credit that he/she actually spent in the educational activity.

Through an agreement between the Union Européenne des Médecins Spécialistes and the American Medical Association, physicians may convert EACCME® credits to an equivalent number of AMA PRA Category 1 Credits™. Information on the process to convert EACCME® credit to AMA credit can be found at www.ama-assn.org/education/earn-credit-participation-international-activities.

Live educational activities, occurring outside of Canada, recognised by the UEMS-EACCME® for ECMEC®s are deemed to be Accredited Group Learning Activities (Section 1) as defined by the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada.

Take-Home Message

• You have seen that we have a variety of methods for airway management in thoracic surgery.

• We must differentiate between the need for providing merely lung collapse in patent airways to facilitate surgery and lung isolation to isolate the ventilated lung from soilage with pus or blood and provide ventilation as such in problematic airways.

• For lung collapse both DLT (with or without incorporated video-cameras) and bronchial blockers are equally good choices. Local expertise and price are guides to use any of the two methods.

• For lung isolation, a DLT is the best option, as it provides easy access for suction and CPAP to the non-ventilated lung and avoids spillage of pus or blood from the non-ventilated lung.

• Newer DLTs or single lumen tubes with a video incorporated allow surveillance of the carina and early detection of tube displacement, especially in scenarios where access to the patient is difficult. It does not, however, preclude the need for fiberoptic bronchoscopes.

• In the scenario of anticipated or unanticipated difficult airway, DLT intubation is usually difficult even if not impossible. Therefore, single-lumen tube intubation and use of bronchial blockers is the method of choice and enforcing DLT intubation only if unavoidable.

• A difficult airway needs teamwork; that means you will need a second anaesthesiologist, a nurse versed in using the appropriate equipment, and an airway trolley.

• Lung transplantation is a special case of difficult airway management; a DLT seems to be the best choice in most cases.

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The educational webinar received an unrestricted grant from Ambu company.

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