BoardsBridgeDLT for Left Pneumonectomy: Anesthesia Rapid Card
Left double-lumen tube placement, fiberoptic confirmation, fluid restriction, and bronchial-stapler vigilance
Left pneumonectomy requires a LEFT-sided DLT confirmed fiberoptically BEFORE and AFTER lateral positioning, with aggressive fluid restriction (no third-space replacement), ARDS-protective OLV (Vt <6 mL/kg, Pplat <30 cmH2O), and vigilance for DLT entrapment in the left mainstem bronchial staple line.
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LEFT DLT for LEFT pneumonectomy — RIGHT DLT risks RUL occlusion in the short right mainstem
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Key numbers
- Vt <6 mL/kg reduces postoperative respiratory failure vs 8 mL/kg (Slinger)
- Vt 6 mL/kg, Pplat <30 cmH2O for ventilated post-pneumonectomy patients (Shanghai)
- Shuttle walk >400 m ≈ peak VO2 >15 mL/kg/min — refer for CPET if ≤400 m (Slinger)
- Post-pneumonectomy pulmonary edema mortality: up to 50%
- Crossmatch 2 units PRBC pre-induction (Slinger)
- Total 19 bronchopulmonary segments; left lung = 9 (Slinger)
Uri Rozen, MD — Licensed Physician, Israel
Source guidelines: Slinger Pneumonectomy Anesthesia 2020 · Shanghai Pneumonectomy Complications 2019
Re-review cadence: 12 months from reviewed date.
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Card ID: dlt-left-pneumonectomy · Path: aba.thoracic.one-lung-ventilation.dlt-left-pneumonectomy