AI Article Synopsis
- Bronchial blocker balloons, when inflated with small air volumes, pose risks of airway injuries in young children, necessitating better guidelines for safe usage.
- The study assessed the necessary air volumes for these balloons in 79 pediatric patients undergoing thoracoscopic surgery, measuring balloon pressure and bronchial diameters to determine optimal occlusion.
- Results indicated that occluding the left mainstem bronchus required less than 1 mL of air without injury risk, while the right required 1.3 mL; overall, high-quality lung isolation was achieved with minimal complications.
Article Abstract
Introduction: Bronchial blocker balloons inflated with small volumes of air increase balloon pressure, involving a risk of airway injury especially in young children. However, there are no established guidelines regarding the appropriate volumes of air required to provide safe bronchial occlusion.
Methods: This study aimed to introduce a novel method for calculating the amount of air required for safe bronchial blocker balloon occlusion for one lung anesthesia in young children. We included 79 pediatric patients who underwent video-assisted thoracoscopic surgery at our hospital. Preoperatively, the balloon pressure and corresponding diameter of 5F bronchial blockers inflated with different volumes of air were measured. Intraoperatively, bronchial diameters measured by computerized tomographic scans were matched to the ex vivo measured balloon diameters. The quality of lung isolation, incidence of balloon repositioning, and airway injury were documented. Postoperatively, airway injury was evaluated through fiberoptic bronchoscopy.
Results: Balloon pressure and balloon diameter showed linear and nonlinear correlations with volume, respectively. The median lengths of the right and left mainstem bronchi were median (interquartile range) range: 5.3 mm (4.5-6.3) 2.7-8.15 and 21.8 (19.6-23.4) 14-29, respectively. Occluding the left mainstem bronchus required <1 mL of air, with a balloon pressure of 27 cm HO. The isolation quality was high with no case of mucosal injury or displacement. Occluding the right mainstem bronchus required a median air volume of 1.3 mL, with a median balloon pressure of 44 cm HO. One patient had poor lung isolation due to a tracheal bronchus and another developed mild and transient airway injury.
Conclusion: The bronchial blocker cuff should be regarded as a high-pressure balloon. We introduced a new concept for safe bronchial blocker balloon occlusion for one-lung ventilation in small children.
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| http://dx.doi.org/10.1111/pan.14964 | DOI Listing |
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