One Lung Ventilation (Exam 4)

Question 1

FiO2

Answer 1

Induction and early in the case: 1.0 FiO2
Decrease during one lung ventilation
–Aids absorption atelectasis in nondependent lung speeding up collapse

Question 2

Tidal Volumes

Answer 2

TLV: 6-8mL/kg
OLV: 4-6mL/kg
Peak pressure less than 35cmH2O
Keep pressure around 25cmH2O

Question 3

Recruitment maneuver

Answer 3

Before lung isolation
During OLV as needed
–Reverses atelectasis in ventilated lung, improving PO2 during OLV

Question 4

PEEP

Answer 4

Routine PEEP: 5-10cmH2O
–No PEEP in pts with obstructive disease (Asthma and Bronchitis)

Question 5

Respiratory Rate

Answer 5

12-16/min
Can go higher if needed

Question 6

PCO2

Answer 6

Permissive hypercapnia during OLV
–Keep PH ≥7.20

Question 7

Vent Mode

Answer 7

Volume or Pressure Control
–Pressure control for pts at risk for lung injury
-bullae
-preexisting lung disease
-pneumoectomy
-lung xplant

Question 8

Management: Dependent / Ventilated Lung

Answer 8

FiO2: 1.0
Confirm position of DLT or Blocker with bronchoscope
Recruitment maneuver (transiently make hypoxemia worse)
PEEP 5-10cmH2O
-except in emphysema pts

Question 9

Management: Nondependent / Surgical Lung

Answer 9

Passive O2: 1-2L/min via suction catheter down DLT
Partial recruitment maneuver followed by CPAP 1-2cm H2O
Intermittent PPV
Flex Bronchoscope lobar insufflation via working channel with 100% O2
Use Blocker to isolate
Small TV’s
Clamp blood flow to nonventilated lung via pulmonary artery

Question 10

Management: Other considerations

Answer 10

Cardiac output optimal
Volatile gas <1.0 MAC to optimize hypoxic pulmonary vasoconstriction and V/Q mismatching
Venovenous ECMO (Extracorporeal Membrane Oxygenation)