An individualized dual-bronchial blocker strategy for one-lung ventilation in a child undergoing S1a segmentectomy for CPAM: a case report

Abstract Introduction For the rare congenital pulmonary airway malformation (CPAM), video-assisted thoracoscopic surgery (VATS) with effective one-lung ventilation (OLV) is the treatment of choice. We present a case where lung isolation was successfully achieved for pediatric VATS using a double-bronchial blocker (BB) technique. Case presentation An 11-year-old girl (36 kg, 150 cm) presented with cough and was found on contrast-enhanced CT to have a cystic lesion in the right upper lobe. She subsequently underwent thoracoscopic resection of a CPAM. After anesthesia induction, attempted occlusion of the right main bronchus with an extraluminally placed 9 F BB failed to achieve a complete seal. The blocker was therefore advanced to the bronchus intermedius to isolate the middle and lower lobes. A second 5 F BB was then placed through the endotracheal tube under bronchoscopic guidance to occlude the right upper lobe bronchus, successfully isolating the target lobe. OLVlasted 79 min during the 102-minute procedure. Excellent lung collapse was achieved with no anesthesia-related complications. The patient was extubated in the operating room and transferred to the PACU in stable condition. She recovered without pulmonary complications and was discharged on postoperative day 7. Conclusions This case suggests that the flexible double-BB strategy is a feasible and effective solution. when standard right main bronchus isolation fails in children, likely due to anatomical variation. The technique provided optimal VATS conditions through complete lung isolation and collapse, offering a valuable alternative for managing complex pediatric airways.