Selective Lobar Blockade With a Bronchial Blocker in Combination With a Double Lumen Tube to Manage Refractory Hypoxemia: A Case Report

We present the case of a 66-year-old woman undergoing right robotic thoracoscopic lower lobectomy with refractory hypoxemia. After several failed attempts to improve oxygenation, we performed lobar isolation of the middle and lower lobes on the operative side utilizing a 5 Fr Arndt endobronchial blocker in combination with an in situ left-sided double lumen endotracheal tube. Once the bronchial blocker was in place in the right bronchus intermedius, 5 cm H(2)O of continuous positive airway pressure was applied via the tracheal lumen to the right upper lobe, significantly improving the patient’s oxygenation allowing for safe completion of the procedure.