Endobronchial Bleeding Associated With Blunt Chest Trauma Treated by Bronchial Occlusion With a Univent Noboru Nishiumi, MD, Tomoki Nakagawa, MD, Ryouta.

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Endobronchial Bleeding Associated With Blunt Chest Trauma Treated by Bronchial Occlusion With a Univent Noboru Nishiumi, MD, Tomoki Nakagawa, MD, Ryouta Masuda, MD, Masayuki Iwasaki, MD, Sadaki Inokuchi, MD, Hiroshi Inoue, MD The Annals of Thoracic Surgery Volume 85, Issue 1, Pages 245-250 (January 2008) DOI: 10.1016/j.athoracsur.2007.07.062 Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Sites of bronchial occlusion with a Univent (Fuji Systems Corporation). Sites of bronchial occlusion were the main bronchi (right and left) in 19 patients, the intermediate bronchial trunk in 9, and the lobar bronchial trunks (right upper, left upper, left lower) in 7. In the main bronchi, differential respiratory management was used for 4 patients. () = patients in whom the right and left sides were ventilated separately, with two different respirators. The Annals of Thoracic Surgery 2008 85, 245-250DOI: (10.1016/j.athoracsur.2007.07.062) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Methods of bronchial occlusion and differential respiratory management of the right and left sides in patients with endobronchial bleeding from the right upper bronchial trunk. The blocker attached to the Univent (Fuji Systems Corporation) is inflated at the inlet to the right upper bronchial trunk to prevent entry of blood from the right upper bronchial trunk into the intermediate bronchus and the left bronchus. One-lung ventilation is begun in continuous positive pressure ventilation (CPPV) mode, with fraction of inspired oxygen (Fio2) at 1.0. Because the Univent blocker has a strawlike opening, pure oxygen is supplied by the blocker lumen at a continuous positive airway pressure (CPAP) of 5 cm H2O to inflate the right middle and lower lobes. In 1 patient with bleeding from the right upper bronchial trunk, in whom oxygen saturation as measured by pulse oximetry (Spo2) was 80% during one-lung ventilation of the left side at Fio2 1.0, this procedure resulted in elevation of Spo2 to 95%, thereby preventing death from hypoxemia. The Annals of Thoracic Surgery 2008 85, 245-250DOI: (10.1016/j.athoracsur.2007.07.062) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Method of inserting the Univent blocker into the left main bronchus. The Univent (Fuji Systems Corporation) is inserted into the trachea to a relatively shallow depth. With the cervical spine stabilized, the patient’s face is directed slightly to the left (1). The cervical segment of the trachea is then manually compressed to the right (2) so that the Univent forms an arch protruding to the right. At the lips, the Univent is rotated counterclockwise (3), and the blocker attached to the Univent is inserted to 7 cm (4). The blocker is advanced from the anterior wall of the trachea toward the left wall and can be inserted easily into the left main bronchus. Air is infused into the blocker cuff at a volume of 5 mL. Disappearance of the respiratory sounds on the left side is confirmed by auscultation. Once the blocker has been inserted into the targeted bronchus, bleeding from the airway through the tracheal tube decreases immediately, facilitating discernment of the inserted side. Blood entering the right bronchus is removed with the bronchoscope, and the location of the blocker within the left main bronchus is adjusted. Finally, the location of the blocker and cessation of movement of the left lung are confirmed by plain chest roentgenogram. The Annals of Thoracic Surgery 2008 85, 245-250DOI: (10.1016/j.athoracsur.2007.07.062) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions