Intraoperative mechanical ventilation strategies for one-lung ventilation

Area of Science:

• Anesthesiology
• Critical Care Medicine
• Respiratory Physiology

Background:

• One-lung ventilation (OLV) presents dual challenges: maintaining adequate oxygenation and protecting the lung from ventilation-induced injury.
• Conflicting recommendations exist for optimizing oxygenation and lung protection during OLV, such as varying inspiratory oxygen fraction (FiO2) and tidal volume (TV).

Purpose of the Study:

• To review recent strategies for one-lung ventilation (OLV) that address the challenges of oxygenation and lung protection.
• To synthesize findings from limited randomized clinical trials on novel OLV approaches.

Main Methods:

• Review of recent literature and randomized clinical trials concerning one-lung ventilation.
• Focus on a contemporary strategy involving adjusted FiO2, tidal volumes, PEEP/CPAP, and recruitment maneuvers.

Main Results:

• A recent strategy for OLV involves potentially decreasing FiO2 and lowering tidal volumes.
• Application of positive end-expiratory pressure (PEEP) to the dependent lung and continuous positive airway pressure (CPAP) to the non-dependent lung are key components.
• Recruitment maneuvers are also considered part of this updated strategy.

Conclusions:

• Newer strategies for OLV aim to reconcile conflicting recommendations for oxygenation and lung protection.
• Factors like anesthetic choice and fluid management significantly influence the success of ventilatory strategies in OLV.
• Recent developments are shifting the classical approach to managing one-lung ventilation.