One-lung ventilation is a specialized technique often required during thoracic surgeries to isolate and protect the operative lung. Managing ventilation in these cases involves careful calculation and adjustment of tidal volume and respiratory pressures. Typically, tidal volume is reduced by approximately one-third to prevent overdistension and potential damage to the functioning lung. Monitoring and adjusting the peak pressures are critical to avoid causing barotrauma while ensuring sufficient ventilation and oxygenation. Pressure-controlled ventilation modes are commonly used in these scenarios to provide more controlled and consistent respiratory support.
| Situation | Problem | Ventilation adjustment |
|---|---|---|
| Routine protective ventilation | Lung collapse and ventilator-associated lung injury | Tidal volumes of 6 to 8 mL/kg ideal body weight with PEEP of at least 5 cm H2O |
| Alveolar collapse during anesthesia | Collapsed alveoli | Recruitment maneuvers to reopen collapsed alveoli, used judiciously to avoid hypotension or pneumothorax, particularly in vulnerable lungs or thoracic surgery where suture lines may be at risk |
| Laparoscopy | CO2 insufflation presses upward on the diaphragm, reducing lung volume and compliance | Potentially higher peak pressures; a pressure-controlled mode may manage these pressures more effectively |
| Trendelenburg position | Increased abdominal pressure against the diaphragm | Pressure-controlled mode to keep ventilation consistent without exceeding safe pressure limits |
| One-lung ventilation | Overdistension of and damage to the functioning lung | Reduce tidal volume by approximately one-third and monitor peak pressures; pressure-controlled modes are commonly used |
