In most patients requiring mechanical ventilation, both lungs are inflated and deflated together. One lung ventilation (OLV) refers to mechanical separation of the two lungs to allow ventilation of only one lung, while the other lung is compressed by the surgeon or allowed to passively deflate. OLV is a standard approach to facilitate surgical exposure for pulmonary and other thoracic surgeries, or may be used to isolate a pathologic from a healthy lung to prevent soiling or to allow differential ventilation.
This topic will discuss the general principles and physiology of OLV, its management, and complications. Devices used for OLV, their placement and comparative performance are reviewed separately. (See "Lung isolation techniques".)
INDICATIONS AND CONTRAINDICATIONS
One lung ventilation (OLV) is used either to improve exposure to the surgical field in thoracic surgery, or to anatomically isolate one lung from a pathologic process of the other lung. Contraindications to OLV include dependence on bilateral mechanical ventilation, and intraluminal airway masses that restrict access to the tracheobronchial tree.
Surgical exposure — An immobile, collapsed lung in the vicinity of the surgical field improves access to the thoracic cavity, thus OLV is used during many thoracic surgical procedures:
- Pulmonary resection, including pneumonectomy, lobectomy, and wedge resection
- Video-assisted thoracoscopic surgery (VATS), including wedge resection, biopsy, and pleurodesis
- Minimally invasive cardiac surgery
- Thoracic vascular surgery
- Mediastinal surgery
- Thoracic spine surgery
- Esophageal surgery