The Use of Bronchial Blockers for Providing One-Lung Ventilation

The use of BBs as a means for providing OLV has grown. There are multiple choices of BB that are currently available and have been discussed in this review. The use of a BB can be especially advantageous in a patient with a difficult airway in whom a SLT can be used and then will not have to be changed. Whether a DLT or BB is chosen as the technique, it is important that the practitioner be familiar with the device.²² The ABCs of lung isolation that must be adhered to have been described by Peter Slinger as A: anatomy (know the anatomy); B: bronchoscopy (be skilled in, and use bronchoscopy); and C: chest imaging (review the chest imaging to learn of possible airway abnormalities).⁵² There may be added time and cost when using a BB, but patient safety always should come first.⁵³ Avoiding having to change from an SLT to a DLT may be the primary safety issue in a patient who is considered to be a difficult intubation, and a BB may be preferred in these situations.^54,55 This would be especially true if there are also concerns with mask ventilation, such as in a morbidly obese patient; mask ventilation or placement of an LMA might become necessary as the backup if the tube exchange was not successful.