Airway pressure changes during one-lung ventilation

This investigation analyzed the changes in inspiratory airway pressures during transition from two-lung to one-lung ventilation in patients tracheally intubated with a double-lumen endotracheal tube (DLT) using a classical method of intubation without fiberoptic bronchoscopy. All patients were anesthetized in a standardized fashion. Ventilation was accomplished with the Siemens 900 constant-flow mechanical ventilator (Solna, Sweden). Peak (Ppeak) and plateau (Pplateau) inspiratory airway pressures were recorded with an on-line respiratory monitor before and after clamping the tracheal limb of the DLT. The position of the DLTs was evaluated by fiberoptic bronchoscopy with the patient in supine position. Of the 51 intubations, the DLT was malpositioned in 15 cases (29.5%). Ppeak and Pplateau increased significantly when switched from two-lung ventilation to one-lung ventilation in both correctly and incorrectly positioned DLTs. When the DLT was in a correct position, Ppeak increased by a mean of 55.1% and Pplateau increased by a mean of 41.9%. When the DLT was malpositioned, this increase was significantly larger (74.9% and 68.8%, respectively). Three tests commonly used as markers of malpositioned DLTs were evaluated based on the data of this study, and it was established that, although the pressure differences related to position are statistically significant, as a single value, they cannot be used for clinical decision making.