Dr K Khaing Saw Lwin discusses different techniques for one lung ventilation in infants and children, including single-lumen endotracheal tubes, double-lumen endobronchial tubes, balloon-tipped bronchial blockers, and Univent tubes. Single-lumen tubes are simplest but have limitations, while double-lumen tubes provide better lung isolation but smallest size is only for children 8 years and older. Balloon-tipped bronchial blockers placed through a single-lumen tube are preferred for children under 6 as they allow lung isolation with fiberoptic guidance. Univent tubes also offer easy positioning of the bronchial blocker. Tube size selection depends on age and

1. Dr K Khaing Saw Lwin
MBBS,MRCSEd,MMedSc(Thoracic Surgery)

2. •One lung ventilation for infants and
children is achieved
-single-lumen ETT
-double-lumen endobronchial tube
-balloon-tipped bronchial blockers
- a Univent tube

4. •Single-lumen endotracheal tube
(ETT)---the simplest means of lung
isolation
•Tube size selection and depth of
insertion --- depend on age
•After tracheal intubation, the ETT can
deliberately be advanced into
bronchus to isolate the lungs.

7. •Preferred for emergencies
(contralateral tension pneumothorax)
•Challenges
-the inadequacy to provide a good seal
in the bronchus
-unable to provide a collapsed lung for
the operative site
-or protect the normal lungs from
contamination

9. •Double-lumen endobronchial tube
(EBT)---numerous advantages in
executing successful one lung
ventilation
•The bronchial cuff’s high
volume/low pressure properties
reduce the risk of ischemic pressure
damage to airway

10. •size for double-lumen EBT for children
either
1. direct measurement of the bronchial
width by chest radiograph or
2. computing the diameter of the left
bronchus (WLB) via known tracheal width
(WT)
•using the formula WLB = (0.4 × WT) +
3.3.
•Smallest size available is 26 F(children 8
years old and above)

14. •Balloon-tipped bronchial blockers
(BB) ---‘technique of choice’ in
paediatric patients, under the age
of 6 years
•Balloon-tipped BB can advance
down or alongside the single lumen
ETT(using a fiberoptic
bronchoscope (FOB) )

20. •The Univent tubes with movable
bronchial blocker--- an advantage of
technical ease in positioning and
placement

23. *References
*One lung ventilation strategies for infants and
children undergoing VATS, indian journal of
anaesthesia