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What clinical problems are associated with the place-ment and use of double-lumen endobronchial tubes?
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.
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