Intra-Operative Ventilation Strategies for Thoracic Surgery

  • Denham S. Ward


Ventilatory strategies for one-lung ventilation (OLV) should take into account preventing both intra-operative hypoxemia and postoperative ventilator-induced lung injury (VILI). Although a lung-protective strategy utilizing low tidal volumes (6 mL/kg) and limited inflation pressures (<30 cm H2O) are clearly indicated for patients with acute respiratory distress syndrome, the evidence for the use of low tidal volumes for OLV is not as compelling. However, it seems prudent at this time to limit tidal volumes and inflation pressures during OLV, providing high breathing frequencies or PaCO2 are not required. 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. The addition of external PEEP does not consistently improve oxygenation and has not been shown to reduce the incidence of VILI. An “open lung” maneuver utilizing several breaths of high inspiratory and expiratory pressures may improve oxygenation, but the hemodynamic consequences of the maneuver must be considered. No evidence-based specific recommendations can be made for OLV, but available evidence does help the anesthesiologist select the best strategy for an individual patient and surgery.


Continuous Positive Airway Pressure Tidal Volume Acute Lung Injury Acute Respiratory Distress Syndrome High Tidal Volume 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Denham S. Ward
    • 1
  1. 1.Department of AnesthesiologyUniversity of RochesterRochesterUSA

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