Use of the Arndt wire-guided endobronchial blocker to facilitate one-lung ventilation for pediatric empyema during video-assisted thoracoscopy

Background: Video-assisted thoracoscopic surgery (VATS) has emerged as an innovative and popular procedure for the management of postpneumonic empyema in children refractory to a medical response. One-lung ventilation is required during VATS. In this study, we evaluated the efficacy of intraoperative wire-guided endobronchial blockade (WEB) for achieving 1-lung ventilation during a thoracoscopic procedure for pediatric empyema. Methods: Eighteen patients undergoing a VATS approach for evacuation of an empyema cavity were studied. We used a new device, a bronchial blocker tube, to establish 1-lung ventilation. Intraoperative oxygenation, ventilation, and hemodynamics, as well as the duration of the operation during 1-lung ventilation were recorded. The number of unsuccessful placement attempts, number of malpositionings of the device, and the number of secondary dislodgements of the device after turning the patient into the lateral position were also counted. The quality of lung deflation and inflation was rated by the surgeon under direct visualization as either excellent, fair, or poor. Results: The mean operative time was 80 ± 10.8 (range, 50∼120) min. The mean peak inspiratory pressure under 1-lung ventilation was 28.7 ± 3.6 cmH₂O, and no desaturation was noted. A number of unsuccessful placement attempts were required in 1 patient (1/18) for left-sided VATS. No malpositioning or secondary dislodgement of the device was noted. The quality of lung deflation was judged as being excellent in all patients. Conclusions: VATS can safely and effectively be performed in children with a proper anesthetic technique. With the development and clinical use of this new device, the bronchial blocker tube proved to be effective and easy to use for establishing 1-lung ventilation in a pediatric population.