Physiology of One-Lung Ventilation

  • Philip M. Hartigan


Published estimates of the incidence of hypoxemia during ­one-lung ventilation (OLV) have decreased from 25% in the 1970s to currently less than 10% (1 2). Technical improvements (fiberoptic bronchoscopy, DLT design, etc.) account for some of this progress (Chapter 8). Improved understanding of the physiology of OLV has also contributed importantly and is the topic of this chapter.


One-lung ventilation Hypoxic pulmonary vasoconstriction Multiple inert gas elimination technique Perfusion Ventilation Hypoxemia Continuous positive airway pressure Positive end-expiratory pressure High-frequency jet ventilation Air insufflation 

Selected References

  1. 1.
    Karzai W, Schwarzkopf K. Hypoxemia during one-lung ventilation. Anesthesiology. 2009;110:1402–11.PubMedCrossRefGoogle Scholar
  2. 2.
    Brodsky JB, Lemmens HJ. Left double-lumen tubes:clinical experience with 1170 patients. J Cardiothorac Vasc Anesth. 2003;17:289–98.PubMedCrossRefGoogle Scholar
  3. 3.
    Kozian A, Schilling T, Schutze H, Hachenberg T, Hedenstierna G. Lung ­computed tomography density distribution in a porcine model of one-lung ventilation. Br J Anaesth. 2009;102(4):551–60.PubMedCrossRefGoogle Scholar
  4. 4.
    Lohser J. Evidence-based management of one-lung ventilation. Anesthesiol Clin. 2008;26:241–72.PubMedCrossRefGoogle Scholar
  5. 5.
    Hurford W, Kolker AC, Strauss HW. The use of ventilation/perfusion lung scans to predict oxygenation during one-lung anesthesia. Anesthesiology. 1987;67:841–44.PubMedCrossRefGoogle Scholar
  6. 6.
    Slinger P, Suissa S, Triolet W. Predicting arterial desaturation during one-lung anaesthesia. Can J Anaesth. 1992;39:1030–5.PubMedCrossRefGoogle Scholar
  7. 7.
    Slinger P, Kruger M, McRae K, et al. Relation of the static compliance curve and positive end-expiratory pressure to oxygenation during one-lung ventilation. Anesthesiology. 2001;95(5):1098–2006.CrossRefGoogle Scholar
  8. 8.
    Nakatsuka M, Wetstein L, Keenan RL. Unilateral high-frequency jet ventilation during one-lung ventilation for thoracotomy. Ann Thorac Surg. 1995;59(6):1610–4.PubMedCrossRefGoogle Scholar
  9. 9.
    Ko R, McRae K, Darling G, et al. The use of air in the inspired gas mixture during two-lung ventilation delays lung collapse during one-lung ventilation. Anesth Analg. 2009;108(4):10926.CrossRefGoogle Scholar
  10. 10.
    Ducros L, Moutafis M, Castelain M, et al. Pulmonary air trapping during two-lung and one-lung ventilation. J Cardiothorac Vasc Anesth. 1999;13(1):35–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Gay G, Rodarte J, Hubmayer R, et al. The effects of positive end-expiratory pressure on isovolemic flow and dynamic hyperinflation in patients receiving mechanical ventilation. Am Rev Resp Dis. 1989;139:621–6.PubMedGoogle Scholar
  12. 12.
    Tugrul M, Camci E, Karadeniz H, et al. Comparison of volume controlled with pressure controlled ventilation during one-lung anesthesia. Br J Anaesth. 1997;79:306–10.PubMedGoogle Scholar
  13. 13.
    Unzueta MC, Casa JI, Moral MV. Pressure-controlled versus volume-controlled ventilation during one-lung ventilation for thoracic surgery. Anesth Analg. 2007;104:1029–33.PubMedCrossRefGoogle Scholar
  14. 14.
    Tusman G, Bohm SH, Sipman FS, Maisch S. Lung recruitment improves the efficiency of ventilation and gas exchange during one-lung anesthesia. Anesth Analg. 2004;98(6):1604–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Cinnella G, Grasso S, Natale C, et al. Physiologic effects of a lung-recruiting strategy applied during one-lung ventilation. Acta Anasthesiol Scand. 2008;52(6):766–75.CrossRefGoogle Scholar
  16. 16.
    Bardoczky G, Szegedi L, d’Hollander A, et al. Two-lung and one-lung ventilation in patients with chronic obstructive pulmonary disease: the effects of position and FiO2. Anesth Analg 2000;90(1):35–41.Google Scholar
  17. 17.
    Dennehy KC, Dupuis JY, Nathan HJ, Wynands JE. Profound hypoxemia during treatment of low cardiac output after cardiopulmonarty bypass. Can J Anaesth. 1999;46:56–60.PubMedCrossRefGoogle Scholar
  18. 18.
    Casthely PA, Lear F, Cottrell JE, Lear E. Intrapulmonary shunting during induced hypotension. Anesth Analg. 1982;61:231–5.PubMedCrossRefGoogle Scholar
  19. 19.
    Hartigan P, Formanek V, Shernan S, et al. Inhaled nitric oxide fails to improve gas exchange during one-lung ventilation. Anesthesiology. 1996;A1165.Google Scholar
  20. 20.
    Sticher J, Scholz S, Boning O, et al. Small dose nitric oxide improves oxygenation during one-lung ventilation: An experimental study. Anesth Analg. 2002;95:1557–62.PubMedCrossRefGoogle Scholar
  21. 21.
    Moutafis M, Dalibon N, Liu N, et al. The effects of intravenous almitrine on oxygenation and hemodynamics during one-lung ventilation. Anesth Analg. 2002;94:830–4.PubMedCrossRefGoogle Scholar
  22. 22.
    Schwarzkopf K, Schreiber T, Bauer R, et al. The effects of increasing doses of isoflurane and desflurane on pulmonary perfusion and systemic oxygenation during one-lung ventilation in pigs. Anesth Analg. 2001;93:1434–38.PubMedCrossRefGoogle Scholar
  23. 23.
    Slinger P, Scott W. Arterial oxygenation during one-lung ventilation. A comparison of isoflurane and enflurane Anesthesiology. 1995;82(4):940–46.Google Scholar
  24. 24.
    Wang J, Russell G, Page R, et al. Comparison of the effects of desflurane and isoflurane on arterial oxygenation during one-lung ventilation. Br J Anaesth. 1998;81(6):850–3.PubMedGoogle Scholar
  25. 25.
    Wang J, Russell G, Page R, et al. A comparison of the effects of desflurane and isoflurane on arterial oxygenation during one-lung ventilation. Anaesthesia. 2000;55(2):167–73.PubMedCrossRefGoogle Scholar
  26. 26.
    Abe K, Shimizu T, Takashina M, et al. The effects of propofol, isoflurane, and sevoflurane on oxygenation and shunt fraction during one-lung ventilation. Anesth Analg. 1998;87:1164–9.PubMedGoogle Scholar
  27. 27.
    Schwarzkopf K, Schreiber T, Preussler N-P, et al. Lung perfusion, shunt fraction, and oxygenation during one-lung ventilation in pigs: the effects of desflurane, isoflurane, and propofol. J Cardiothorac Vasc Anesth. 2003;17(1):73–5.PubMedCrossRefGoogle Scholar
  28. 28.
    Szegedi LL, Van der Linden P, Ducart A, et al. The effects of acute hypovolemic hemodilution on oxygenation during one-lung ventilation. Anesth Analg. 2005;100:15–20.PubMedCrossRefGoogle Scholar
  29. 29.
    Levin AI, Coetzee JF. Arterial oxygenation during one-lung anesthesia. Anesth Analg. 2005;100(1):12–4.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Philip M. Hartigan
    • 1
  1. 1.Division of Thoracic Anaesthesia Department of AnaesthesiologyPerioperative and Pain Medicine, Brigham and Women’s HospitalBostonUSA

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