One lung ventilation (Lung isolation)

Keyword

One lung ventilation, Lung isolation

Definition

thoracic procedure를 편리하게 하기 위하여 op side의 폐를 고의적으로 collapse 시키는 것.

Indications

1. cardiac, thoracic, mediastinal, vascular, esophageal, chest cavity를 포함하는 orthopedic procedures를 시행받는 환자에서 one lung ventilation을 편리하게 하고자 할때
2. bronchopleural fistula, pulmonary hemorrhage, whole-lung lavage 등에서 반대쪽 폐로부터 보호하기 위해.
3. LT나 pulmonary thromboendarterectomy이후 unilateral reperfusion injury 가 발생한 경우에 다른 패턴의 ventilation을 하고자 할때.
4. 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

1. double-lumen tube(direct laryngoscopy, via tube exchanger, fiberoptically)
2. Bronchial blockers(Arndt, Cohen, Fuji, EZ Blocker)
3. Univent tube
4. Endobronchial tube
5. Endobronchial tube advanced into bronchus

Complications

1. hypoxemia due to tube malplacement, tube occlusion, or excessive degrees of venous admixture with one-lung ventilation
2. traumatic laryngitis
3. tracheobronchial rupture resulting from traumatic placement or overinflation of the bronchial cuff
4. 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-