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Correspondence  |   July 2003
An Alternative Way to Use Fogarty Balloon Catheter for Perioperative Lung Isolation
Author Notes
  • University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Article Information
Correspondence
Correspondence   |   July 2003
An Alternative Way to Use Fogarty Balloon Catheter for Perioperative Lung Isolation
Anesthesiology 7 2003, Vol.99, 240. doi:
Anesthesiology 7 2003, Vol.99, 240. doi:
To the Editor:—
We read with great interest the review of current techniques for perioperative lung isolation by Dr. Campos. 1 Use of the Fogarty® balloon catheter (FBC®) (Edwards Lifesciences, Irvine, CA) as a bronchial blocker to achieve lung isolation is reviewed. It is suggested that a standard endotracheal tube (ETT) of at least 6.0-mm internal diameter is required to use the FBC® for lung isolation.
We suggest an alternate way to use the FBC® for lung isolation. In our experience, under direct laryngoscopy it is possible to place the FBC independently through the vocal cords alongside the ETT. A fiberoptic bronchoscope may or may not be required to guide the FBC into the desired position. This alternate technique obviates the need for an ETT larger then 6.0-mm internal diameter and a right-angle connector with self-sealing diaphragm. Introducing the FBC independently alongside the ETT may also preclude the need for ventilation interruption for placement of the FBC in critically ill mechanically ventilated patients requiring high positive end expiratory pressure. Use of the FBC alongside the ETT instead of through the ETT also decreases the risk of dislodging the FBC that may occur when the fiberoptic bronchoscope is withdrawn alongside the FBC.
The FBC is considerably cheaper than double-lumen tubes, Univent® endotracheal tubes, and wire-guided endobronchial blockers (WEB®) for lung isolation and is readily available in operating rooms. The disadvantages include a low-volume, high-pressure cuff, and its lack of hollow center. The FBC, therefore, may increase the risk of tracheal mucosal damage if used for a prolonged time, and it cannot be used to insufflate oxygen, evacuate air, or perform pulmonary toilet. We also disagree with the author about using a fiberoptic bronchoscope suction port to evacuate air from the lung. We believe that using active suction may collapse the proximal bronchioles and bronchi and leave the distal alveoli distended, thus deteriorating the situation.
We recommend that the size of the ETT may not limit the selection of the FBC for one-lung ventilation. Introducing the FBC independently alongside the ETT may be considered for critically ill mechanically ventilated patients, and to avoid risk of FBC dislodgment.
Reference
Reference
Campos, JH: Current techniques for perioperative lung isolation in adults. A nesthesiology 2002; 97: 1295–1301Campos, JH