General principles of one lung ventilation
- Martin Ma, MD
Martin Ma, MD
- University of Toronto
- Peter D Slinger, MD, FRCPC
Peter D Slinger, MD, FRCPC
- Section Editor — Thoracic Anesthesia; Vascular Anesthesia
- Professor of Anesthesia
- Toronto General Hospital
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
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- INDICATIONS AND CONTRAINDICATIONS
- - Surgical exposure
- - Lung isolation
- VENTILATION STRATEGIES
- Low tidal volume
- Permissive hypercapnia
- Positive end-expiratory pressure
- - Auto PEEP in obstructive disease
- Low airway pressures
- Oxygen concentration
- Protective ventilation
- MANAGEMENT OF HYPOXEMIA
- Predicting hypoxemia during OLV
- Treatment of hypoxemia
- ANESTHETIC CHOICE
- Intravenous versus inhalation anesthetics
- General versus combined thoracic epidural/general anesthesia
- SUMMARY AND RECOMMENDATIONS