[From Two to One - Techniques for One-lung Ventilation]

Area of Science:

• Anesthesiology
• Thoracic Surgery
• Respiratory Physiology

Background:

• One-lung ventilation (OLV) is essential for thoracic surgical procedures, requiring precise lung isolation.
• Double-lumen tubes (DLTs), developed in 1949 and refined since, are the standard for OLV.
• Alternative devices like bronchial blockers (BBs) exist for specific clinical scenarios.

Purpose of the Study:

• To review the historical development and current applications of DLTs for OLV.
• To discuss advancements in DLT technology, including video-assisted devices.
• To compare DLTs with BBs and outline strategies for managing hypoxemia during OLV.

Main Methods:

• Review of historical advancements in lung separation techniques.
• Description of modern DLTs and their characteristics.
• Discussion of bronchial blockers as an alternative to DLTs.
• Overview of intraoperative hypoxemia management strategies during OLV.

Main Results:

• DLTs, pioneered by Carlens and improved by Robertshaw, are the established standard for OLV.
• Modern DLTs offer varied sizes and materials for patient-specific selection.
• Video-assisted DLTs simplify placement and reduce the need for bronchoscopy.
• BBs present an alternative but require specialized expertise and have higher dislocation rates.
• Management of hypoxemia involves recruitment maneuvers, PEEP, CPAP, or ECMO.

Conclusions:

• A thorough understanding of airway anatomy, device options, and ventilation strategies is vital for safe and effective OLV.
• DLTs remain the gold standard, with technological advancements improving their application.
• BBs offer a viable alternative in select cases, necessitating careful consideration of risks and benefits.