Keyword
One lung ventilation, Lung isolation
Definition
thoracic procedure를 편리하게 하기 위하여 op side의 폐를 고의적으로 collapse 시키는 것.
Indications
- cardiac, thoracic, mediastinal, vascular, esophageal, chest cavity를 포함하는 orthopedic procedures를 시행받는 환자에서 one lung ventilation을 편리하게 하고자 할때
- bronchopleural fistula, pulmonary hemorrhage, whole-lung lavage 등에서 반대쪽 폐로부터 보호하기 위해.
- LT나 pulmonary thromboendarterectomy이후 unilateral reperfusion injury 가 발생한 경우에 다른 패턴의 ventilation을 하고자 할때.
- 수술 종류 : Pulmonary resection, Thoracoscopy, Pulmonary hemorrhage, Bronchopleural fistula, Nonpulmonary surgery(thoracic aorta, esophagus), Bronchial surgery(tumor, trauma), Lung transplantation, Whole lung lavage, Independent lung ventilation
Options for Lung isolation
- double-lumen tube(direct laryngoscopy, via tube exchanger, fiberoptically)
- Bronchial blockers(Arndt, Cohen, Fuji, EZ Blocker)
- Univent tube
- Endobronchial tube
- Endobronchial tube advanced into bronchus
Complications
- hypoxemia due to tube malplacement, tube occlusion, or excessive degrees of venous admixture with one-lung ventilation
- traumatic laryngitis
- tracheobronchial rupture resulting from traumatic placement or overinflation of the bronchial cuff
- inadvertent suturing of the tube to a bronchus during surgery (extubation시 tube가 안 뽑아져서 알게됨.)
Further readings
Reference
Miller’s Anesthesia, 8th edition, P.1955-
Morgan and Mikhail's Clinical Anesthesiology, 5th edition, P.548-