2.

Advantages, disadvantages and limitations of selective endobronchial devices

Device	Advantages	Disadvantages	Limitation in the use
Legenda: [ID] internal diameter; [ILV] independent lung ventilation; [ETT] endotracheal tube; [CPAP] continuous positive airway pressure; [DLT] double-lumen tube; [PEEP] positive end-expiratory pressure; [BBs] bronchial blockers.
Bronchial intubation using a single tube	- Easy to perform also in emergency - Total exclusion of one lung - No need of special equipment or devices - The tube can be withdrawn into the trachea permitting bilateral lung ventilation - Can be used in all ages when suitable length of tube is available	- Easy dislodgement of the tube changing patien's position or surgical manipulations of the lung - Inadequate ventilation in case of obstruction - Slow collapse of lung and difficult bronchus seal (uncuffed tube) and risk of contamination of contralateral lung - Difficult collapse and re-expand lung during surgery	- Possible obstruction of upper lobe bronchus, when right mainstem is intubated - Impossible bilateral bronchosuctioning - Can require use of fiberscope - ILV is impossible - Positioning requires skill and expertise
UniventTM tube	- Total exclusion of one lung - The blocker tube can be withdrawn into the main tube, permitting bilateral lung ventilation - O2 supplementation, bronchosuc- tioning in excluded lung - Can be used for selective lung segmental lobi isolation	- Severe bronchial mucosa ischemia if low volume/ high pressure cuff is used - Difficult collapse and re-expand the lung during surgery - Impossible bilateral bronchosuctioning - High resistance to gas flow because the blocker channel occupies large part of the ETT	- Needs the fiberscope for positioning - Requires special and high costly devices - The smallest available size for pedia- trics is 3.5 mm ID - ILV is impossible - Not easy to use - Positioning requires skill and expertise
BBs (fogarty embolectomy, arteriosep-tostomy and pulmo-nary artery catheters) and Arndt blocker®	- Total one lung isolation - Bronchosuctioning, O2 supple- mentation and CPAP application (arterioseptostomy and pulmonary artery catheters)	- Severe bronchial mucosa ischemia if low volume/ high pressure cuff is used - Total airway obstruction if inflated balloon slips back into the trachea - Easy dislocation during surgical operation and difficult re-positioning - Difficult collapse and re-expand the lung during surgery - Not easy to use	- Needs the fiberscope for positioning - Insufficient ventilation for tracheal ID in younger children - Requires special and high costly devices - Can be used in the age when suitable catheter is available - ILV is impossible - Positioning requires high skill and expertise
Pediatric DLT	- Total exclusion of one lung and easy collapse and re-expansion of collapsed lung - Easy placement of left sided DLT - Allows ILV (different tidal volume and PEEP in each lung) - O2 supplementation and CPAP application in the excluded lung - Bilateral bronchosuction	- Easy obstruction of the tube for small ID if active humidifier is not used - Need for re-intubation with conventional single lumen tube for continuing ventilation in postoperative care - Right sided DLTs are difficult to place without obstruction of the right upper lobe bronchus	- Positioning needs skills and experience - Bronchosuctioning could be difficult due to the small size and length of the DLT - Correct positioning or dislocation could need fiberscope - The use is limited > 6-8 years of age for marketed DLT