Differential lung ventilation as an alternative to one-lung ventilation during thoracotomy. Report of three cases

Investigation was carried out on three elderly patients undergoing thoracotomy. During one-lung ventilation using a Robertshaw double-lumen tube, the PaO2 decreased below 11.7 kPa despite ventilation of the dependent lung with 100% oxygen. Differential lung ventilation was then initiated by partial occlusion of the adapter limb to the nondependent lung, whilst maintaining unrestricted ventilation of the dependent lung. In the three patients, differential lung ventilation increased the PaO2 to 15-37.2 kPa. The increased PaO2 may be attributed to diffusion oxygenation via the partially inflated, nondependent lung. Differential lung ventilation can be used during thoracotomy whenever one-lung ventilation is followed by hypoxaemia, despite adequate ventilation of the dependent lung with 100% oxygen.