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J Thorac Cardiovasc Surg 1994;107:1171-1172
© 1994 Mosby, Inc.

LETTERS TO THE EDITOR

Univent endotracheal tube: Twelve-year experience

Hiroshi Inoue, MD

First Department of Surgery
School of Medicine
Tokai University
Isehara, Kanagawa 259-11, Japan

To the Editor:

Thoracic surgeons have long recognized the advantages of one-lung ventilation; this especially true for lung transplantation Go 1 and the rapidly emerging field of video-assisted thoracoscopy. Go 2

I wish to report on the use of the endotracheal tube with a movable blocker (Univent, Fuji Systems Corporation, Tokyo, Japan; Fig. 1) that I designed in 1981. Go Go 3-5 We have been using the Univent tube for procedures requiring collapse of one lung at Tokai University Hospital for more than 12 years.



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  		Fig. 1. Univent endotracheal tube.

 
The Univent tube has certain advantages for the surgeon over conventional methods for one-lung ventilation. The bronchial blocker can be manipulated under bronchoscopic guidance to occlude the whole or part of the target lung. If preoperative diagnostic bronchoscopy is anticipated, a size 9.0 or 8.5 mm inner diameter Univent tube may be used as a guide for the large–outer diameter fiberoptic bronchoscope with forceps channel without changing from a single-lumen endotracheal tube for bronchoscopy to a double-lumen endobronchial tube for one-lung ventilation. In addition, postoperative ventilation may be achieved simply by pulling the deflated blocker back into its channel in the main tube assembly, obviating a tube change at the end of the case.

The Univent tube is positioned as with any endotracheal tube and can be rotated toward the target lung to give guidance to the blocker Go 3; additional guidance can be provided by giving the blocker shaft a twist while advancing the blocker under direct vision. Go 4 In cases of anatomic distortion, such as with ascending thoracic aneurysm, the fiberoptic bronchoscope can be used as a stylet and the Univent tube can be advanced to the subcarinal level of the left main-stem bronchus, where the blocker can be positioned and the main tube assembly can be withdrawn. Once the chest is opened, the blocker may be inflated under direct vision with the fiberoptic bronchoscope and the lung may thus be occluded. We deflate the lung by gently squeezing the air out of the lung before inflating the blocker, by aspirating the air from the lung by syringe suction on the blocker lumen, or by waiting for absorption atelectasis to collapse the lung.

We have used the Univent tube in more than 1300 thoracic operations in a 12-year period. Only in a few cases may the Univent tube be inappropriate; these cases are lung lavage, differential lung ventilation, and suction of tenacious secretions from below the bronchial blocker. I believe that the Univent endotracheal tube is a safe and convenient device for one-lung ventilation, with specific advantages over conventional methods.

References

  1. Scheller MS, Kriett JM, Smith CM, Jamieson SW. Airway management during anesthesia for double-lung transplantation using a single-lumen endotracheal tube with an enclosed bronchial blocker. J Cardiothorac Anesth 1992;6:204-7.
  2. Lewis RJ, Caccavale RJ, Sisler GE, Mackenzie JM. One hundred consecutive patients undergoing video-assisted thoracic operations. Ann Thorac Surg 1992;54:421-6.[Abstract]
  3. Inoue H, Shohtsu A, Ogawa J, Kawada S, Koide S. New device for one-lung anesthesia: endotracheal tube with movable blocker. J THORAC CARDIOVASC SURG 1982;83:940-1.[Medline]
  4. Inoue H, Shohtsu A, Ogawa J, Koide S, Kawada S. Endotracheal tube with movable blocker to prevent aspiration of intratracheal bleeding. Ann Thorac Surg 1984;37:497-9.[Abstract]
  5. Inoue H, Suzuki I, Iwasaki M, Ogawa J, Koide S, Shohtsu A. Selective exclusion of the injured lung. J Trauma 1993;34:496-8.[Medline]



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 Anesth. Analg.Home page
R. A. Peragallo and J. D. Swenson
Congenital Tracheal Bronchus: The Inability to Isolate the Right Lung with a Univent Bronchial Blocker Tube
Anesth. Analg., August 1, 2000; 91(2): 300 - 301.
[Abstract] [Full Text] [PDF]

This Article
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