Journal of Emergencies, Trauma, and Shock
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 Table of Contents    
LETTER TO EDITOR  
Year : 2011  |  Volume : 4  |  Issue : 3  |  Page : 438
Double-lumen endobronchial tube and alternatives in massive hemoptysis: How do you want to save lives?


Department of Emergency and Intensive Care Medicine, Military Hospital Val-de-Grâce, 74 Boulevard Port-Royal, Paris-75005, France

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Date of Web Publication16-Aug-2011
 

How to cite this article:
Jean-Vivien S, Clément D, Jean-Pierre T, Yves A. Double-lumen endobronchial tube and alternatives in massive hemoptysis: How do you want to save lives?. J Emerg Trauma Shock 2011;4:438

How to cite this URL:
Jean-Vivien S, Clément D, Jean-Pierre T, Yves A. Double-lumen endobronchial tube and alternatives in massive hemoptysis: How do you want to save lives?. J Emerg Trauma Shock [serial online] 2011 [cited 2019 Nov 17];4:438. Available from: http://www.onlinejets.org/text.asp?2011/4/3/438/83895


Sir,

We read with great interest the letter of L. Santana-Cabrera and M. Fernαndez Arroyo. [1] We fully agree with the conclusion that selective intubation with a double lumen endotracheal tube is a vital method in saving lives in massive hemoptysis. The goal of selective intubation is to protect the nonbleeding lung from blood flood.

However, despite its utility, malpositioning of double lumen tubes can occur. We remind the prospective study of Klein and colleagues, who have detected some malpositioning in a population of 172 patients. [2] They have revealed misplaced double-lumen tube by fiberoptic bronchoscope in 74 patients (45%) after fist placement and in 93 patients (54%) after patient positioning. [2] In the Haponik survey, only less than 50% of physicians used a double lumen tube in case of massive hemoptysis. [3] A majority of chest clinicians (71%) prefers to use a large-bore single lumen tube, rather than a double lumen tube, because they acknowledged a lack of proficiency with the second one. [3]

Intubation with a double lumen tube, does not allow managing hemoptysis with endoscopy. Flexible fiberoptic bronchoscope cannot be introduced through a double lumen tube because its working channel is too narrow, even with the maximal size of tube (45 French). Widespread bronchoscopy is an important examination to localize the bleeding site and to perform immediately some efficient treatments applicable in critical situations. Using bronchoscopy, temporary control of hemoptysis can be achieve with balloon tamponade therapy, topical instillations with vasoconstrictive agents or with cold saline solution, or sometimes laser therapy. [4],[5] So a large bore endotracheal single lumen tube (more than 8 mm of internal diameter) is often preferred to allow fiberoptic bronchial explorations. [4] Moreover, bronchial exclusion techniques using some balloon catheters can be performed without using double lumen tube. Intensivist can occlude the bleeding bronchus on a segmental level with a Fogarty catheter or with another kind of bronchus-blocking catheters, protecting the healthy bronchial tract against bleeding coming. [4]

Furthermore, bleeding can be important in this situation. In intubated and ventilated patients, tracheobronchial or tubal occlusions can be caused by even small amounts of blood. [5],[6] So sometimes, what stand out most is to clear vigorously the airways of blood. Whereas it could be difficult to remove clots with a limited lumen tube and clearance of blood in quantity is more practicable through a large tube. [6]

To conclude, the positioning of a double lumen endotracheal tube requires experience and its use prevents institution of fiberoptic techniques to locate and stop bleeding. In critical situation, intensivist has to choose his strategy in order to save lives. There is no evidence of superiority for one strategy. But according to us, in case of important bleeding, bronchoscopy seems to be an unavoidable and useful instrument to manage massive hemoptysis.

 
   References Top

1.Santana-Cabrera L, Arroyo MF, Rodriguez AU, Sanchez-Palacios M. Double-lumen endobronchial tube in the emergency management of massive hemoptysis. J Emerg Trauma Shock 2010;3:305.   Back to cited text no. 1
[PUBMED]  Medknow Journal  
2. Klein U, Karzai W, Bloos F, Wohlfarth M, Gottschall R, Fritz H, et al. Role of fiberoptic bronchoscopy in conjunction with the use of double-lumen tubes for thoracic anesthesia: A prospective study. Anesthesiology 1998;88:346-50.  Back to cited text no. 2
    
3.Haponik EF, Fein A, Chin R. Managing life-threatening hemoptysis: has anything really changed? Chest 2000;118:1431-5.  Back to cited text no. 3
    
4.Jean-Baptiste E. Clinical assessment and management of massive hemoptysis. Crit Care Med 2000;28:1642-7.  Back to cited text no. 4
    
5.Düpree HJ, Lewejohann JC, Gleiss J, Muhl E, Bruch HP. Fiberoptic bronchoscopy of intubated patients with life-threatening hemoptysis. World J Surg 2001;25:104-7.  Back to cited text no. 5
    
6.Hakanson E, Konstantinov IE, Fransson SG, Svedjeholm R. Management of life-threatening haemoptysis. Br J Anaesth 2002;88:291-5.  Back to cited text no. 6
    

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Correspondence Address:
Schaal Jean-Vivien
Department of Emergency and Intensive Care Medicine, Military Hospital Val-de-Grâce, 74 Boulevard Port-Royal, Paris-75005
France
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-2700.83895

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