title: Prevention of lung-to-lung aspiration during emergency thoracic surgery: an experimental study.
abstract: BACKGROUND
  Lung separation is essential for an emergency thoracic surgery for massive hemoptysis. When using a double lumen tube (DLT), a commonly adopted lung separation device during thoracic surgery, a water-tight seal of endobronchial cuff is crucial to prevent lung-to-lung aspiration of blood. In this study, we investigated the fluid sealing characteristics of the endobronchial cuff of a DLT and examined the effect of gel lubrication on the fluid leakage beyond the endobronchial cuff of DLT.
  
  
  METHODS
  An artificial tracheobronchial tree was intubated with a DLT. In the first phase of the study, the intra-cuff pressure of endobronchial cuff of DLT was set to 25, 50, or 100 cmH2O (n = 7, each), and the non-dependent bronchus was filled with 5 ml of water. Fluid leakage to the dependent bronchus beyond the endobronchial cuff was collected for 6 h. The time until leakage was first detected and the time until 100% leakage occurred were measured. In the second phase, the endobronchial cuff was coated with either saline (group C, n = 10) or lubricant gel (group GEL, n = 10), and the same parameters were measured.
  
  
  RESULTS
  In the first phase of the study, the times to first leakage and 100% leakage at an intra-cuff pressure of 25 cmH2O were 21.0 (7.0 - 59.0) sec and 3.0 (2.0 - 4.0) min, respectively. Higher intra-cuff (50 and 100 cmH2O) resulted in longer time for the first leakage and 100% leakage, but the duration was not long enough for clinical purpose. In the second phase, all the DLTs in group C showed 100% fluid leakage during the 6-hour period. In contrast, in group GEL, fluid leakage beyond the endobronchial cuff was detected only in 50% of the DLTs and none of the DLT showed 100% fluid leakage during the study. Among the DLTs which exhibited fluid leakage, the time to first leakage was 252.0 (171.0-305.0) min and the leakage volume at the end of the study period was 0.3〔0.0-1.8〕ml.
  
  
  CONCLUSIONS
  Endobronchial cuff of DLT cannot prevent fluid leakage beyond the endobronchial cuff, but lubricant gel coating on the endobronchial cuff can effectively reduce the lung-to-lung aspiration.
authors: Department of Anesthesiology and Pain Medicine, Borame Medical Center, Seoul National University, College of Medicine, Boramae-ro 5-gil, Dongjak-gu, Seoul, Kyoneggido 156-707 South Korea.
authors: Jin-Young
authors: JY
authors: Hwang
authors: Department of Anesthesiology and Pain Medicine, Pusan National University Hospital, Biomedical Research Institute, Pusan National University, School of Medicine, 179 Gudeok-ro, Seo-Gu, Busan, 602-739 South Korea.
authors: Jiseok
authors: J
authors: Baik
authors: Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seoul National University, College of Medicine, 300 Gumidong Bundanggu, Seongnamsi, Kyoneggido 463-707 South Korea.
authors: Sahngun Francis
authors: SF
authors: Nahm
authors: Department of Thoracic Surgery, Sejong General Hospital, 489-28 Hohyun-Ro, Sosa-Gu, Bucheon-Si, Kyoneggido 422-711 South Korea.
authors: Dongjin
authors: D
authors: Kim
authors: Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seoul National University, College of Medicine, 300 Gumidong Bundanggu, Seongnamsi, Kyoneggido 463-707 South Korea.
authors: Young-Tae
authors: YT
authors: Jeon
authors: Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seoul National University, College of Medicine, 300 Gumidong Bundanggu, Seongnamsi, Kyoneggido 463-707 South Korea.
authors: Jinhee
authors: J
authors: Kim
authors: Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seoul National University, College of Medicine, 300 Gumidong Bundanggu, Seongnamsi, Kyoneggido 463-707 South Korea.
authors: Seongjoo
authors: S
authors: Park
authors: Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seoul National University, College of Medicine, 300 Gumidong Bundanggu, Seongnamsi, Kyoneggido 463-707 South Korea.
authors: Sunghee
authors: S
authors: Han
keywords: Aspiration; Double lumen tube; Endobronchial cuff; Hemoptysis; Lung separation; Thoracic surgery