Management of hypoxemia during one lung ventilation^[1]

Gradual desaturation:

Ensure F_iO₂ = 1.0

Check DLT/BB placement with fiberoptic bronchoscopy

Suction airway as needed

Optimize cardiac output

Recruit ventilated lung

Apply PEEP 5 cm to ventilated lung (except COPD)

Apply CPAP 5 to 10 cm non-ventilated lung (after recruitment)

Intermittently ventilate both lungs

Partial ventilation of operative lung:

i) Selective lobar collapse

ii) O₂ insufflation to non-operative lobes

Mechanical restriction of pulmonary blood flow to non-ventilated lung

If hypoxemia is acute and severe (O₂ saturation <90 percent), 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.

F_iO₂: fractional inspired concentration of oxygen; DLT: double-lumen tube; BB: bronchial blocker; PEEP: positive end expiratory pressure; COPD: chronic obstructive pulmonary disease; CPAP: continuous positive airway pressure; O₂: oxygen.

Reference:

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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خرید پکیج

Management of hypoxemia during one lung ventilation[1]

Management of hypoxemia during one lung ventilation^[1]