key: cord-0764894-60mzwb2u
authors: Ponnaiah, V.; Bailey, C. R.
title: One‐lung ventilation during the COVID‐19 pandemic
date: 2020-06-07
journal: Anaesthesia
DOI: 10.1111/anae.15159
sha: 9a5d76bdb2c4500f5a50f93d757b4cb98a2390b6
doc_id: 764894
cord_uid: 60mzwb2u

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We assemble the double-lumen tube with two paediatric ClearTherm 3 heat and moisture exchange (HME) filters (Intersurgical Ltd., Wokingham, UK) attached to the catheter mounts before anaesthesia in addition to a standard HME filter at the distal end of the catheter mount ( Fig. 1 ). There is no increased resistance within the circuit when these extra HME filters are added and they serve two purposes. First, they make the circuit symmetrical, with less likelihood of kinking. Second, because they are sited proximal to the patient's airway, accidental disconnection of any parts of the circuit should not result in aerosol generation within the operating room. Using two clamps eliminates potential contamination from the patient's lungs and we can isolate parts of the circuit in order to insert and remove in line suction as needed, rather than using standard suction catheters, with their inherent risk of aerosol generation. Thornton et al. state that a flexible bronchoscope should be used to check double-lumen tube positioning following tracheal intubation and after positioning the patient laterally. They write that clinical confirmation of double-lumen tubes is associated with a malposition rate of up to 35% and quote two references, one of which was a study involving a single anaesthetist whose thoracic experience was unknown [2] and the other a review that quoted the study [3] . Use of a bronchoscope risks generation of aerosols because the port through which the bronchoscope is introduced is not airtight. We, therefore, 

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