Abstract
Purpose
To explore why two pigs died in the course of a study in which a double-lumen tube (DLT) was used to achieve single-lung ventilation, the bronchial anatomy of all six pigs involved in the study was examined at autopsy.
Methods
Autopsy involved examination of the lungsin situ and subsequent dissection of the lung tissue from the lobular bronchi.
Results
All six pigs were found to have an apical lobe (or lobular) bronchus arising from the trachea. In three it was on the right, as is usual in pigs, and in three, including the two that died, it was on the left. The mainstem bronchi to both lungs were short in all pigs, with major segmental bronchi arising just distal to the carina.
Conclusion
The bronchial anatomy of the pig is such that the inflated cuffs of commercially available DLTs may cause partial or complete obstruction of the apical bronchi of one or both lungs, regardless of the side of the tracheal bronchus. The transmission of the resulting breath sounds across the narrow pig thorax can make auscultation unhelpful in assisting with optimal tube placement.
Résumé
Objectif
Afin de déterminer la cause du décès de deux porcs au cours d’une étude pendant laquelle on a utilisé un tube double lumière (TDL) pour réaliser la ventilation unipulmonaire, on a procédé à l’autopsie de l’anatomie bronchique des six porcs de l’étude.
Méthode
L’autopsie comprenait l’examen des poumonsin situ suivi d’une dissection du tissu pulmonaire des bronches lobulaires.
Résultats
On a trouvé chez les six porcs une bronche apicale lobulaire issue de la trachée. À droite chez trois porcs et à gauche chez les autres, incluant les deux animaux décédés pendant l’étude. Les troncs bronchiques des deux poumons étaient courts chez tous les porcs et les bronches segmentaires principales prenaient naissance près de la carène.
Conclusion
Lanatomie bronchique du porc est telle que les ballonnets gonflés des TDL commercialement offerts peuvent causer une obstruction partielle ou complète des bronches apicales d’un ou des deux poumons, peu importe de quel côté se trouve la bronche trachéale. La transmission du murmure vésiculaire qui suit peut rendre l’auscultation de l’étroit thorax du porc inutile dans la tentative d’une mise en place optimale du tube.
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Mouton, W.G., Pfitzner, J., Bessell, J.R. et al. Bronchial anatomy and single-lung ventilation in the pig. Can J Anesth 46, 701–703 (1999). https://doi.org/10.1007/BF03013963
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DOI: https://doi.org/10.1007/BF03013963