SESSION TITLE: Bronchology/Interventional Student/Resident Case Report Posters I
SESSION TYPE: Medical Student/Resident Case Report
PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM
INTRODUCTION: Isolation of the bleeding bronchial segments can aid in reducing flooding the rest of the airway and may tamponade the bleeding (1). We describe a case were the combination of a double lumen endotracheal (DLE, Size 37 F, Rüsch Bronchopart®, Duluth GA) and the Arnd® spherical bronchial blocker cuff (Cook Critical Care, Bloomington IN) were used simultaneously to isolate the bleeding lung segment.
CASE PRESENTATION: A 65 year old male smoker with stage IV non-small cell lung cancer diagnosed one year previously was admitted to our Critical Care Unit for progressive shortness of breath, fever and cough. The patient was intubated due to respiratory failure, required vasopressor support and was treated with broad spectrum antibiotics for febrile neutropenia and oseltamivir for H1N1 influenza. On day 9 of his hospital stay, the patient developed massive hemoptysis and required increasingly higher ventilator parameters. Bronchoscopy was performed, demonstrating active bleeding from the right bronchus intermedius. The patient’s Hg had dropped from initial value of 12.6 to 7.0 g/dL. In an attempt to control the hemoptysis and preserve as much of the non-bleeding airway, a DLE tube was introduced. With the aid of a pediatric fiberscope a concomitant bronchial blocker was introduced to the level of the bronchus intermedius to spare the patient’s right upper lobe and optimize gas exchange (Fig#1).
DISCUSSION: For the management of massive hemoptysis, both selective intubation of the affected lung and the use of the double lumen endotracheal tube have been described (2). The goal of these techniques is to protect non-bleeding lung from blood flood.
CONCLUSIONS: In this case, we illustrate the feasibility of combining DLE intubation with endobronchial ballooning to further isolate the bleeding lung segments and maximize gas exchange. This can be particularly important in patients with poor lung reserve.
Reference #1: Cahill BC, Ingbar DH. Massive hemoptysis. Assessment and management. Clin Chest Med. 1994 Mar;15(1):147-67.
Reference #2: Awad H, Malik O, Hollis K, et al. Bronchial blocker versus double-lumen tube for lung isolation with massive hemoptysis during cardiac surgery.J Cardiothorac Vasc Anesth. 2013 Jun;27(3):e26-8.
DISCLOSURE: The following authors have nothing to disclose: Menfil Orellana-Barrios, Andres Yepes-Hurtado, Isham Huizar
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