Differential lung ventilation during thoracotomy

The effect of differential lung ventilation on arterial PO2 and PCO2 was compared to that achieved during one-lung ventilation in 8 patients undergoing thoracotomy. In all patients, OLV of the dependent lung, while collapsing the nondependent lung, was associated with lowering of the arterial PO2. DLV using a special double-lumen tube adaptor was then initiated; the dependent lung was preferentially ventilated by 75-80% of the tidal volume, while the nondependent lung on the operative side was only ventilated by 20-25% of the tidal volume. DLV improved oxygenation and maintained adequate carbon dioxide elimination, with minimal inflation of the nondependent lung into the surgical field. DLV may be used to increase oxygenation whenever conventional OLV is associated with hypoxemia despite the use of 100% oxygen.