Incomplete Drainage of Total Pulmonary Lavage as a Cause of Double-Lumen Tube Malposition: A Case Report

Introduction: Although a variety of techniques are available to achieve lung isolation in adults, double lumen tube (DLT) placement is essential for performing bronchoalveolar lavage (BAL) because it allows rapid conversion from one-lung ventilation to two-lung ventilation as well as optimal suction and drainage of lavage solution. Nevertheless, one of the main complications that can occur during BAL is retrograde migration of the DLT into the trachea, which can lead to interruption of ventilation and instillation of lavage fluid in both lungs. Case Presentation: 60-year-old man underwent total bronchoalveolar lavage under general anesthesia with placement of a DLT. During the procedure, drainage of lavage fluid was less than the amount of fluid instilled into the lung. A neutral position of the cervical spine and a deeper insertion of the bronchial tube were not sufficient to avoid the withdrawal of the DLT. Results: BAL could be performed by increasing the passive drainage time, and by active aspiration of the residual lung solution. The procedure was completed after observing that the last aliquot of the lung lavage was transparent. Discussion: Fluid retention with the consequent increase in pressure in the tracheobronchial tree favored the withdrawal of the DLT towards the trachea obstructing the airway. Conclusion: In case of incomplete drainage of lung lavage fluid accompanied by increased airway pressure, active aspiration of lavage fluid should be performed with a bronchoscope to avoid malposition of the DLT.