The Science Journal of the American Association for Respiratory Care

1997 OPEN FORUM Abstracts

ENDOBRONCHIAL AIRWAY MANAGEMENT USING A COMBINATION CAPNOGRAPHY AND RESPIRATORY PROFILE MONITOR-

Chris Cella, RRT, John Dobrozsi, RRT, Josh Benditt, MD. University of Washington Medical Center, Seattle, WA

Introduction- Independent lung ventilation (ILV), and dual lumen endotracheal tubes (DLETT) are used in a variety of clinical settings. Simple activities such as head movement or routine turning may affect DLETT position adversely. The misplacement of the DLETT can go undetected by RCP's. The use of respiratory profile monitors that include capnography and respiratory mechanics can assist in detection of tube placement. Improper DLETT placement and cuff inflation or deflation can quickly lead to potential life threatening situations. We report the experience in two such patients as summarized below. Case 1- A 67 yo male with severe emphysema, underwent Lung Volume Reduction Surgery (LVRS). One month following surgery, he was admitted to the ICU for pneumonia and was electively intubated in the ICU with a 39 Fr DLETT. Verification of DLETT placement was evaluated by a colormeteric device which was attached to a Carlens Y adapter, by auscultation and chest radiograph. Four hours after ventilation was initiated, the patient's condition deteriorated with decreasing SPO2's and hypotension. A pair of CO_{2}SMO Plus Respiratory Profile Monitors (Novarnetrix Medical Inc., Wallingford CT) were placed on the tracheal and bronchial lumens of each tube. With both cuffs inflated, the ETCO2 was 0 and volume and flow waveforms were flat from the bronchial lumen. ETCO2 and waveforms were within normal limits on the tracheal lumen. When the bronchial lumen was deflated, volume, flow, and ETCO2 waveforms returned. A bronchoscopy revealed a moderate amount of edema partially obstructing the left bronchial lumen. The bronchial cuff was reinflated, and once again ETCO2, flow and volume waveforms decreased to zero baseline. The patient was transferred to the OR so that his airway could be stabilized. Case 2- A 46 yo male with a history of a right lung transplant, and left LVRS was admitted for acute respiratory distress secondary to pneumonia. He became increasingly tachypneic, and hypertensive and was electively intubated under bronchoscopic observation with a 39 Fr DLETT. During intubation the bronchial cuff was noted to be "high" and barely occluding the L mainstem bronchus even though the tube had been advanced as far as possible without sacrificing secure stabilization at the patients lip. ILV was initiated and respiratory mechanics/ETCO2 were monitored using two CO_{2}SMO Plus monitors connected to each lumen respectively. The ETCO2 value was noted to be 0 (zero) and the negative deflection of the flow waveform was absent from the bronchial tube. The Servo ventilator low exhaled volume alarm activated, but it was unclear as to the etiology of the violation. Exhaled volume from the tracheal lumen was noted to be greater than the delivered volume and the ETCO2 remained within normal limits. The bronchial cuff was determined to be ineffective at occluding the L mainstem. Ventilation was continued using a single ventilator wyed to the endobronchial tube and the bronchial cuff deflated. Discussion- In these two cases, independent monitoring of ETCO2, and flow waveforms from both lumens of DLETT resulted in the diagnosis of potential life threatening conditions. The authors feel that monitoring of these parameters to be of great value, and that continued study of their use is necessary.

OF-97-101

You are here: RCJournal.com » Past OPEN FORUM Abstracts » 1997 Abstracts » ENDOBRONCHIAL AIRWAY MANAGEMENT USING A COMBINATION CAPNOGRAPHY AND RESPIRATORY PROFILE MONITOR-