Utilizing an Endobronchial Blocker and a Flexible Bronchoscope for Transbronchial Cryobiopsies in Diffuse Parenchymal Lung Disease

lung being biopsied has been described [1, 5, 6] . However, a rigid tracheoscope is generally needed because the luminal diameter of regular-size endotracheal tubes is typically insufficient to accommodate both a bronchoscope and a blocker simultaneously [1] . Additionally, a technique using a supraglottic airway with general anesthesia has also been described to accommodate the need for both an endobronchial blocker and a flexible bronchoscope in the central airways [5] . Here, we describe a new technique that does not require rigid bronchoscopy or general anesthesia. An 8.0 Smiths ® cuffed wire spiral endotracheal tube is loaded over the flexible bronchoscope. Without the use of the multiport airway adapter, the guide loop of a lubricated and deflated Arndt endobronchial blocker is secured around the distal tip of the bronchoscope ( fig. 1 a, b). The patient is then fiberoptically intubated using the flexible bronchoscope, with the endobronchial blocker riding alongside the bronchoscope and the endotracheal tube through the oropharynx, larynx, and central airways ( fig. 1 c). Once the endobronchial blocker has been directed into the main stem bronchus on the side to be biopsied, the guide loop is loosened, releasing it from the bronchoscope, where it remains in position ( fig. 1 d). The bronchoscope is withdrawn to the mid-trachea and the patient is fiberoptically intubated with the endotraConventional bronchoscopic lung biopsies play a minimal role in the diagnosis of diffuse parenchymal lung diseases due to the small sample size and crush artifact of the biopsied specimen [1] . Recently, transbronchial cryobiopsies have shown promise in their diagnosis [2–4] . However, given the limited experience with cryobiopsies for this purpose to date, pneumothorax and bleeding risk will remain a concern until more safety data become available. To manage the potentially increased bleeding risk, the preemptive placement of a deflated endobronchial blocker in the airway of the Published online: November 14, 2014