Endobronchial Bleeding Associated With Blunt Chest Trauma Treated by Bronchial Occlusion With a Univent

• Published in: The Annals of thoracic surgery Vol. 85; no. 1; pp. 245 - 250
• Main Authors: Nishiumi, Noboru, MD, Nakagawa, Tomoki, MD, Masuda, Ryouta, MD, Iwasaki, Masayuki, MD, Inokuchi, Sadaki, MD, Inoue, Hiroshi, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 2008; Elsevier Science
• Subjects: Adolescent; Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Bronchi - injuries; Bronchoscopy - methods; Cardiology. Vascular system; Cardiothoracic Surgery; Embolization, Therapeutic - instrumentation; Emergency Treatment; Female; Follow-Up Studies; Hemothorax - etiology; Hemothorax - mortality; Hemothorax - therapy; Humans; Intubation, Intratracheal; Male; Medical sciences; Pneumology; Positive-Pressure Respiration; Retrospective Studies; Risk Assessment; Surgery; Survival Rate; Thoracic Injuries - complications; Thoracic Injuries - diagnosis; Thoracic Injuries - mortality; Treatment Outcome; Wounds, Nonpenetrating - complications; Wounds, Nonpenetrating - mortality; 15; Occlusion; Association; Treatment; Bronchus; Anesthesia; Thorax; Circulatory system; Cardiology; Hemorrhage; Trauma
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2007.07.062

Background Endobronchial bleeding in patients with blunt chest trauma can lead to death by suffocation. The conditions leading to bronchial bleeding usually require surgical treatment; however, for diffuse lung contusion, conservative treatment is possible if the bronchial bleeding can be controlled. Methods Sites, methods, and outcomes of occlusion of the affected bronchus by endobronchial blocker used with a Univent endotracheal tube (Fuji Systems Corporation, Tokyo, Japan) in 35 patients (29 men, 6 women; mean age, 26 ± 13 years) with diffuse lung contusion, treated from 1988 to 2004, were analyzed. Results The right main bronchus was occluded in 7 patients, left main bronchus in 12, intermediate bronchial trunk in 9, and secondary bronchi in 7. Four patients who developed hypoxemia underwent differential ventilation. Bronchial occlusion was performed 118 ± 139 minutes after arrival and continued 26 ± 13 hours. Twenty-nine patients survived; 1 died of pulmonary abscess and 5 died due to brain injury. Conclusions Bronchial occlusion should be performed soon after trauma in patients with endobronchial bleeding. The Univent has three advantages in such patients: (1) it prevents the inflow of blood from the affected bronchus into the unaffected lung; (2) the tamponade effect of the endobronchial blocker stops bronchial bleeding; and (3) air embolus due to air flowing from the bronchus into the pulmonary veins can be prevented. Use of a tube for one-lung ventilation with which the trauma surgeon is familiar is advisable. The Uniblocker tube (Fuji Systems Corporation) allows occlusion of the affected bronchus without reinsertion of a single-lumen tracheal tube.