New concepts of the management of one-lung ventilation

Hypoxemia is considered to be the most important challenge during one-lung ventilation. Recent studies, however, have shown that one-lung ventilation can involve some lung damage and can therefore be per se a cause of hypoxemia.

It has been shown that some parameters of one-lung ventilation are associated with an increased probability of lung injury. High tidal volumes can trigger an increase in some inflammatory mediators in both experimental and clinical settings. High inspiratory pressures and/or a collapse of alveoli in every respiratory cycle would lead not only to an impairment of oxygenation, but also to a further incidence of 'postpneumonectomy pulmonary edema', the earlier definition of lung injury associated with one-lung ventilation.

Hypoxemia should always be considered as the most important challenge during one-lung ventilation. One should also keep in mind, however, that some ventilatory strategies can even be harmful.