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Ventilation Strategies for Thoracic Surgery

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Clinical Thoracic Anesthesia

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Abstract

The purpose of one-lung ventilation (OLV) during thoracic surgery is to provide an optimal surgical access while maintaining optimal oxygenation (SpO2 > 90%) and avoiding acute lung injury (ALI). The three key components of OLV strategy are: use of low VT, artificial recruitment maneuvers, and application of positive end-expiratory pressure (PEEP). Pressure control ventilation (PCV) is the preferred mode of ventilation during OLV as it results in more homogenous distribution of VT in comparison to volume control ventilation (VCV). The incidence of intraoperative hypoxemia during OLV is 1–10%. The immediate treatment in case of severe hypoxemia (oxygen saturation < 90%) is to increase FiO2 to 1.0 and resumption of two-lung ventilation (TLV). Treatment options include lung recruitment and application of continuous positive airway pressure (CPAP) to the operative lung. Pharmacological therapy for intraoperative hypoxemia includes use of vasoconstrictors like almitrine, phenylephrine on the operative side, and vasodilators such as inhaled NO in the dependent-ventilated lung.

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Authors and Affiliations

  1. Institute of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India

    Nitin Sethi

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  1. Nitin Sethi
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Editors and Affiliations

  1. Institute of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India

    Jayashree Sood

  2. Institute of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India

    Shikha Sharma

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Sethi, N. (2020). Ventilation Strategies for Thoracic Surgery. In: Sood, J., Sharma, S. (eds) Clinical Thoracic Anesthesia. Springer, Singapore. https://doi.org/10.1007/978-981-15-0746-5_11

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  • DOI: https://doi.org/10.1007/978-981-15-0746-5_11

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  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-15-0745-8

  • Online ISBN: 978-981-15-0746-5

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