Management of One-lung Ventilation: Impact of Tidal Volume on Complications after Thoracic Surgery. No study to date has definitively demonstrated any specific advantage of low tidal volume (VT) ventilation during OLV in the absence of other ventilatory strategies, such as positive end-expiratory pressure (PEEP) ( Blank RS, Colquhoun DA, Durieux ME, et al. It is very difficult to pinpoint tidal volume, for example, as a single factor contributing to lung injury during OLV. The definition of what is considered protective OLV is mainly influenced by expert opinion, evidence gathered from two-lung ventilation in general surgical patients, and a small number of clinical trials. There is very little data that specifically supports a particular approach to management of OLV in terms of clinical outcomes. Evidence-based management of one-lung ventilation. One-lung ventilation during and after thoracic surgery increases the risk of volutrauma, barotrauma, atelectrauma, and oxygen toxicity, all of which are serious complications that cause ventilator-induced lung injury ( Lohser J. Appropriate ventilatory settings for thoracic surgery: intraoperative and postoperative. In the case of thoracic surgery patients, a ‘multiple-hit' theory suggests that a combination of surgery-related factors, one-lung ventilation, underlying diseases and co-morbidities, prior therapy, and other unidentified events may result in greater susceptibility to ALI ( Lytle FT, Brown DR. Lung injury results from mechanical stress caused by hyperinflation, hyperperfusion, and cyclic recruitment/de-recruitment, together with proinflammatory or biochemical factors. Many different factors can contribute to perioperative ALI. Numerous studies have been conducted to determine the most appropriate strategy for mechanical ventilation during OLV. Mechanical ventilation during one-lung ventilation (OLV), also known as single-lung ventilation, has three goals: (I) to aid in carbon dioxide elimination, (II) to maintain oxygenation, and (III) to reduce postoperative lung dysfunction.
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