If the patient does not already have a secure airway, the airway should be secured as mentioned previously. One-lung ventilation is indicated in this situation if the patient is bleeding from one lung and protection of the other lung is required or to improve surgical exposure (lower priority). Once the airway is secured, there are several ways to obtain one-lung ventilation. The easiest and safest technique would be to place a bronchial blocker (BB) through the endotracheal tube and direct it to the affected lung with fiberoptic bronchoscopy before inflating the distal cuff. A limitation to the use of a BB is the inability to adequately suction the isolated lung.

Another method of obtaining one-lung ventilation would be to change the endotracheal tube to a DLT using a Cook exchange catheter. The major disadvantages of DLT placement are losing a previously secured airway and aspiration occurring while attempting to change the tube; improper DLT size selection; and iatrogenic tracheobronchial injury during insertion.

References

• Kanellakos GW, Slinger P. Intraoperative one-lung ventilation for trauma anesthesia. In: Smith CE, ed. Trauma Anesthesia. 2nd ed. Cambridge University Press; 2015:555-568.