One-lung Ventilation
One
lung ventilation (OLV) is the term used in thoracic
anaesthesia to describe the ability to ventilate one of a patient’s lungs, allowing the other one to collapse. This article will describe indications for OLV, techniques used to achieve OLV, the physiological changes associated with OLV and ways that oxygenation can be improved during OLV. . Although OLV is not mandatory for all such procedures, it almost always improves access to the operation field and expedites the process of operation. For this reason and because anesthesiologists' expertise in placement and monitoring of double-lumen tubes (DLTs) has increased, OLV is now used for almost all thoracic operations in which the
lung is operated on or in which the collapse of the
lung improves access to the operation field.During OLV, although only one
lung is ventilated, both lungs are perfused. In a recent study,1 we found that hypoxemia during OLV, defined by a decrease in arterial hemoglobin oxygen saturation (Sao2) to less than 90%, occurred in 4% of patients whose lungs were ventilated with a fraction of inspired oxygen (Fio2) greater than 0.5. Other studies2–5 using similar definitions of hypoxemia place the rate at 5–10%. Hypoxemia during OLV may affect the safety of the patient and is a challenge for the anesthesiologist and for the surgeon.
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