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

One-lung ventilation (OLV) is a crucial technique in thoracic surgery, enabling effective lung isolation for procedures such as lung resections, lung-transplant, and the management of unilateral pulmonary diseases. The development of double-lumen tubes (DLTs) in 1949 by Carlens revolutionized lung separation, providing controlled ventilation of one lung while the other is deflated. Frank Robertshaw's modifications in 1962 improved safety and usability, making DLTs the gold standard for OLV. Modern DLTs, available as left- and right-sided DLTs, vary in size and material, allowing individual selection based on patient anatomy and procedure. Correct placement, verified via bronchoscopy, ensures optimal ventilation and minimizes complications like hypoxemia or airway trauma. Recent advancements include video-assisted DLTs (e.g., VivaSight), integrating real-time imaging to simplify placement and reduce the need for additional bronchoscopy.Bronchial blockers (BBs) offer an alternative to DLTs, particularly for patients with difficult airways or pediatric patients. However, BBs require advanced expertise and may dislocate more frequently than DLTs.Effective management of intraoperative hypoxemia during OLV includes recruitment maneuvers, PEEP, CPAP, or in severe cases, extracorporeal membrane oxygenation (ECMO). A comprehensive understanding of airway anatomy, device options, and ventilation strategies is crucial to the safe and effective application of OLV.