A suggestion for safe lung deflation during one-lung ventilation in COVID-19 suspect or positive patients | Association of Anaesthetists
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A suggestion for safe lung deflation during one-lung ventilation in COVID-19 suspect or positive patients

A suggestion for safe lung deflation during one-lung ventilation in COVID-19 suspect or positive patients

Institution of one-lung ventilation using a double lumen tube (DLT) or bronchial blocker in a COVID-19 suspect or positive patient might increase the risk of staff exposure to a high viral load, through shedding into the theatre atmosphere. ACTACC-UK recommends that it is vital to occlude access to the non-ventilated lung [1]. However, the lung needs to be deflated before occluding the tube, and advice on how to do this safely is lacking.

We suggest the following procedures:

A. Deflating the lung using a catheter mount and heat and moisture-exchanging filter (HMEF)
1. Apply clamps to occlude the tube on the patient side, and the DLT adapter on the circuit side, of the appropriate limb of the DLT.
2. Disconnect the appropriate DLT adapter from the DLT.
3. Connect a standard catheter mount with the HMEF to the open limb of the DLT.
4. Release the clamp on the patient side and allow deflation of the lung to occur via the catheter mount with the HMEF (Fig. 1).
5. If deflation of the lung is deemed adequate, the clamp on the patient side can be re-applied (Fig. 2).

B. Deflating the lung with application of suction
Instead of connecting the catheter mount with filter at step 3 above, attach a closed suction system to the open limb of the DLT (Fig. 3).

Dr Narotham Reddy Burri
Consultant Cardiothoracic Anaesthetist
Dr Sujey Jayaratnasingam
Consultant Cardiothoracic Anaesthetist
Dr Jon Echebarria
Consultant Cardiothoracic Anaesthetist
UHCW NHS Trust, Coventry.

Figure 1

Letter_on_safe_lung_deflation_Figure 1


Figure 2

Letter_on_safe_lung_deflation_Figure 2


Figure 3

Letter_on_safe_lung_deflation_Figure 3

Reference
1. Society for Cardiothoracic Surgery. Guidance to UK cardiac and thoracic teams for procedures on patients with COVID 19, 2020. https://www.actacc.org/sites/default/files/2020-03/SCTS%20ACTACC%20SCPS%20Theatre%20COVID%20pathway%20Final.pdf (accessed 6/4/20).

Editors note: this video also demonstrates option B.


Stop press: since this letter was accepted, ACTACC have produced similar guidance; see ‘Lung isolation and COVID-19’ at https://actacc.org/guidance-procedures-patients-covid-19 (accessed 9/4/2020).