Endobronchial bleeding associated with blunt chest trauma treated by bronchial occlusion with a Univent.

Abstract

Endobronchial bleeding in patients with blunt chest trauma can lead to death by suffocation. The conditions leading to bronchial bleeding usually require surgical treatment; however, for diffuse lung contusion, conservative treatment is possible if the bronchial bleeding can be controlled. Sites, methods, and outcomes of occlusion of the affected bronchus by endobronchial blocker used with a Univent endotracheal tube (Fuji Systems Corporation, Tokyo, Japan) in 35 patients (29 men, 6 women; mean age, 26 +/- 13 years) with diffuse lung contusion, treated from 1988 to 2004, were analyzed. The right main bronchus was occluded in 7 patients, left main bronchus in 12, intermediate bronchial trunk in 9, and secondary bronchi in 7. Four patients who developed hypoxemia underwent differential ventilation. Bronchial occlusion was performed 118 +/- 139 minutes after arrival and continued 26 +/- 13 hours. Twenty-nine patients survived; 1 died of pulmonary abscess and 5 died due to brain injury. Bronchial occlusion should be performed soon after trauma in patients with endobronchial bleeding. The Univent has three advantages in such patients: (1) it prevents the inflow of blood from the affected bronchus into the unaffected lung; (2) the tamponade effect of the endobronchial blocker stops bronchial bleeding; and (3) air embolus due to air flowing from the bronchus into the pulmonary veins can be prevented. Use of a tube for one-lung ventilation with which the trauma surgeon is familiar is advisable. The Uniblocker tube (Fuji Systems Corporation) allows occlusion of the affected bronchus without reinsertion of a single-lumen tracheal tube.