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Published on: March 6, 2019
One-lung ventilation in pediatric patients: A clinically focused narrative review
L Daniela Smith1, T Wesley Templeton1, Ankita Prakash1
1Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
Insights
Managing one-lung ventilation in pediatric patients needs understanding unique anatomy and physiology. Careful selection of lung isolation methods and awareness of complications are crucial for successful pediatric surgical procedures.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Respiratory Physiology
Background:
- Pediatric patients exhibit unique airway anatomy and respiratory physiology, making them more vulnerable to ventilation changes than adults.
- Effective one-lung ventilation (OLV) management in children necessitates specialized knowledge beyond adult protocols.
Purpose of the Study:
- To outline essential considerations for the successful institution and management of one-lung ventilation in pediatric patients.
- To highlight the importance of understanding pediatric-specific respiratory differences, lung isolation techniques, and potential complications.
Main Methods:
- Review of current literature and clinical practices regarding pediatric one-lung ventilation.
- Discussion of various lung isolation methods, their selection criteria (patient size, age, pathology, surgical needs), and associated risks.
- Exploration of ventilation strategies and perioperative management, including extubation.
Main Results:
- Selection of lung isolation methods in pediatric OLV is multifactorial, depending on patient and surgical factors.
- No definitive evidence supports one ventilation strategy over another, allowing for individualized patient-based choices.
- Awareness of potential complications and proper management are critical for safe pediatric OLV.
Conclusions:
- Successful pediatric one-lung ventilation requires a comprehensive understanding of patient-specific anatomy, physiology, and available isolation techniques.
- Perioperative management, including careful extubation, is vital for optimal outcomes in pediatric surgical patients undergoing OLV.
Abstract:
Successful institution and management of one-lung ventilation in pediatric patients requires knowledge of the unique airway anatomy and respiratory physiology of these patients, options for lung isolation, and awareness of common intra-procedure complications. Pediatric patients are more vulnerable to changes in ventilation as compared to adults due to anatomic and physiologic differences in their respiratory systems. There are several methods for lung isolation available to the clinician, the selection of which depends on a variety of factors including size and age of the patient, pathology involved, and the needs of the surgeon. Each method comes with its own potential pitfalls, which the clinician must be aware of in order to anticipate and manage common complications. Ventilation strategies during one-lung ventilation may also differ based on the aforementioned factors. To date, there is little credible evidence to support a clear benefit of one ventilation strategy over another, so choice can be made on an individual patient basis. The approach to resumption of two-lung ventilation and extubation are also important steps in the perioperative management of these patients.
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