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Anaesthetic Concern For One Lung Ventilation: By-Dr - Bhushan Kinge, M.D. Ims - Bhu, Varanasi
Anaesthetic Concern For One Lung Ventilation: By-Dr - Bhushan Kinge, M.D. Ims - Bhu, Varanasi
ventilation
BY- DR.BHUSHAN KINGE,
M.D.
IMS – BHU , VARANASI
One Lung Ventilation (OLV) is a technique that
allows isolation of the individual lungs and each
lung functioning independently by preparation of
the airway under anaesthesia.
• Indication/contraindication of OLV
• Physiology changes of OLV
• Selection of the methods for OLV
• Management of common problems
associated with OLV.
Introduction
• One-lung ventilation, OLV, means separation of
the two lungs and each lung functioning
independently by preparation of the airway
• OLV provides:
– Protection of healthy lung from infected/bleeding one
– Diversion of ventilation from damaged airway or lung
– Improved exposure of surgical field
• OLV causes:
– More manipulation of airway, more damage
– Significant physiologic change and easily development
of hypoxemia
Absolute indication for OLV
– Isolation of one lung from the other to avoid spillage or
contamination
• Infection
• Massive hemorrhage
– Control of the distribution of ventilation
• Bronchopleural / - cutaneous fistula
• Surgical opening of a major conducting airway
• giant unilateral lung cyst or bulla
• Tracheobronchial tree disruption
• Life-threatening hypoxemia due to unilateral lung disease
– Unilateral bronchopulmonary lavage
Relative indication
– Surgical exposure ( high priority)
• Thoracic aortic aneurysm
• Pneumonectomy
• Upper lobectomy
• Mediastinal exposure
• Thoracoscopy
– Surgical exposure (low priority)
• Middle and lower lobectomies and subsegmental resections
• Esophageal surgery
• Thoracic spine procedure
• Minimal invasive cardiac surgery .
– Postcardiopulmonary bypass status after removal of totally
occluding chronic unilateral pulmonary emboli.
– Severe hypoxemia due to unilateral lung disease.
Two-lung ventilation and OLV
Lateral Decubitus Position
Patient remains in this position to facilitate Thoracic surgery.
Pulmonary blood
80% 20%
flow
HPV
• HPV aids in keeping a normal V/Q relationship by
diversion of blood from underventilated areas,
responsible for the most lung perfusion redistribution
in OLV
V Q V Q V Q
ND
D
Shunt and OLV
• Physiological (postpulmonary) shunt
• About 2-5% CO,
• Accounting for normal A-aD02, 10-15 mmHg
• Including drainages from
– Thebesian veins of the heart
– The pulmonary bronchial veins
– Mediastinal and pleural veins
• Transpulmonary shunt increased due to continued
perfusion of the atelectatic lung and A-aD02 may
increase.
Cardiac output and OLV
• Decreased CO may reduce SvO2 and thus impair
SpO2 in presence of significant shunt
– Hypovolemia
– Compression of heart or great vessels
– Thoracic epidural sympathetic blockade
– Air trapping and high PEEP
Breath sounds are Normal (not diminished) & follow the expected
unilateral pattern with unilateral clamping
The chest rises and falls in accordance with the breath sounds
– FiO2 = 1.0
– Manual ventilation
– Check DLT position with FOB
– Check hemodynamic status
– CPAP (5-10 cm H2O, 5 L/min) to nondependent
lung.
– PEEP (5-10 cm H2O) to dependent lung .
– Intermittent two-lung ventilation.
– Temporary Clamp pulmonary artery of non-
ventilated lung .
Management of hypoxemia during OLV
Pulmonary edema in non ventiated lung-
• Intraoperative collapse .
• handling of lung tissue.
• Imaired capillary function in postoperatve
period.
• Needs Judicious use of perioperative fluid and
vasopressor.
Management of hypoxemia during OLV
• Ability to maintain OLV in lateral decubitus
should be checked prior to start of surgery for
feaesibilit
• airway pressure is to be monitored closely.
• Intermittent inflation of collapsed lung may be
necessary sometimes.
OLV postoperative complications