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خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : -1 مورد

Management of hypoxemia during OLV

Management of hypoxemia during OLV
Immediate treatment of acute desaturation <90%:
Increase FiO2 to 100%
Resume two lung ventilation temporarily if oxygen saturation does not rapidly rise to >90% on 100% FiO2.
Assess for treatable causes:
Check DLT/BB positioning with a FIS.
Suction the ventilated lung via the FIS +/– endotracheal catheter.
Optimize cardiac output.
Options for persistent hypoxemia
Use recruitment maneuvers (short periods of higher airway pressure and larger TV) to re-expand alveoli.
Increase PEEP to the ventilated lung up to 10 cmH2O to minimize atelectasis (caution in patients with COPD).
Deliver O2 to the non-ventilated lung:
  • Insufflate a low flow of O2 (3 L/min) to the non-ventilated lung via a suction catheter inserted into the lumen of the DLT
  • Apply O2 via continuous positive airway pressure (CPAP) 5 to 10 cmH2O to the nonventilated lung
  • Use high-frequency jet ventilation to the nonventilated lung as an alternative to CPAP to improve oxygenation and decrease shunt
Use partial ventilation of operative lung:
  • Employ selective lobar collapse.
  • Insufflate O2/CPAP selectively into the nonoperative lobe(s) of the operative lung via a BB or FIS.
Intermittently resume two-lung ventilation as needed, although this requires interruption of the surgical procedure.
Manually restrict pulmonary blood flow via surgical manipulation to decrease shunting through the non-ventilated lung.
Use nebulized prostacyclin or its derivative iloprost in the ventilated lung.
If hypoxemia is acute and severe (O2 saturation <90%), two lung ventilation should be resumed until oxygenation is felt to be clinically adequate. The patient should be assessed after each maneuver; proceed to the next maneuver if hypoxemia persists. When oxygenation is adequate during one lung ventilation, subsequent steps are not necessary.
BB: bronchial blocker; COPD: chronic obstructive pulmonary disease; CPAP: continuous positive airway pressure; DLT: double-lumen tube; FiO2: fractional inspired concentration of oxygen; FIS: flexible intubating scope; OLV: one lung ventilation; O2: oxygen; PEEP: positive end expiratory pressure; TV: tidal volume.
Reference:
  1. Lohser J, Slinger P. Lung Injury After One-Lung Ventilation: A Review of the Pathophysiologic Mechanisms Affecting the Ventilated and the Collapsed Lung. Anesth Analg 2015; 121:302.
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