clinical problems are associated with the place-ment and use of double-lumen
Depending on the type of tube malposition, and
the side of surgery, hypoxemia or poor surgical exposure may result. In the
case of a bronchopleural fistula, poor separa-tion of the lungs may lead to
loss of tidal volume, hyper-carbia, and hypoxemia. Poor isolation in the case
of hemorrhage or empyema may lead to contamination of the uninvolved lung,
which is in the dependent portion during the surgical procedure and thus is
prone to contamination that is due to gravity.
Forcing the endobronchial tube too distal or
using an excessive volume of air in the bronchial cuff may lead to bronchial
hemorrhage and perforation. Rupture may be more likely if the bronchus has been
weakened by disease such as a mediastinal tumor. A descending thoracic aortic
aneurysm may impinge on the left mainstem bronchus and could possibly be
ruptured if an endobronchial tube is forced past this point of resistance.
Movement of the tube without deflating the cuff may lead to airway trauma,
especially by the endobronchial cuff.