Intraoperative mechanical ventilation strategies for one-lung ventilation

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• 作者：Mert Şentü ; rk ; M.D.^a ; ^{senturkm@istanbul.edu.tr" class="auth_mail" title="E-mail the corresponding author} (Professor of Anaesthesiology) ; Peter Slinger ; M.D.^b ; ¹ ; ^{Peter.Slinger@uhn.ca" class="auth_mail" title="E-mail the corresponding author} (Professor of Anaesthesiology) ; Edmond Cohen ; M.D.^c ; ² ; ^{edmond.cohen@mountsinai.org" class="auth_mail" title="E-mail the corresponding author} (Professor of Anesthesiology ; Director of Thoracic Anesthesia)
• 关键词：one-lung ventilation ; pulmonary gas exchange ; mechanical ventilation
• 刊名：Best Practice Research Clinical Anaesthesiology
• 出版年：2015
• 出版时间：September 2015
• 年：2015
• 卷：29
• 期：3
• 页码：357-369
• 全文大小：580 K

文摘

One-lung ventilation (OLV) has two major challenges: oxygenation and lung protection. The former is mainly because the ventilation of one lung is stopped while the perfusion continues; the latter is mainly because the whole ventilation is applied to only one lung. Recommendations for maintaining the oxygenation and methods of lung protection can contradict each other (such as high vs. low inspiratory oxygen fraction (FiO₂), high vs. low tidal volume (TV), etc.). In light of the (very few) randomized clinical trials, this review focuses on a recent strategy for OLV, which includes a possible decrease in FiO₂, lower TVs, positive end-expiratory pressure (PEEP) to the dependent lung, continuous positive airway pressure (CPAP) to the non-dependent lung and recruitment manoeuvres. Other applications such as anaesthetic choice and fluid management can affect the success of ventilatory strategy; new developments have changed the classical approach in this respect.