Abstract
Ventilatory strategies for one-lung ventilation (OLV) should take into account preventing intraoperative hypoxemia, intraoperative alveolar stress, and postoperative ventilator-induced lung injury (VILI). A lung-protective strategy utilizing low tidal volumes (< 6 mL/kg of predicted body weight) and limited plateau inflation pressures (<25 cm H2O) is clearly indicated for patients at high risk for developing postoperative acute respiratory distress syndrome (ARDS) or acute lung injury (ALI). Based on this recent data, the use of low tidal volumes and inflation pressures during OLV is appropriate as long as high breathing frequencies are not required and permissive hypercapnia is not contraindicated. With appropriate use of pressure and tidal volume alarms, either pressure- or volume-controlled ventilation may be used. Intrinsic positive end-expiratory pressure (PEEP) is common with OLV (utilizing a double-lumen endotracheal tube), and caution is warranted when high respiratory rates (short exhalation times) are utilized.
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