Review Note
Last Update: 02/19/2025 10:47 PM
Current Deck: ACG Part 2::Thoracic SSU
New Card (Unpublished)Currently Published Content
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Commit #286198SS_TS 1.11 Discuss the management of hypoxaemia during one-lung ventilation
Back
Commit #286198
Frequent complication of OLV
SpO2 dips then rises again due to HPV
Actions: ventilated lung
- Increase FiO2, hand ventilate with 100% FIO2. Ensures circuit intact, excludes oxygen delivery failure. Assesses compliance and for secretions.
- Increase minute ventilation.
- Check tube position with fibreoptic; ensure ventilation of main bronchi and not lobar bronchi
- Suction secretions if present
- Maintain perfusion with fluid and vasopressors; increased dead space if perfusion down
- Apply PEEP to ventilated lung (could worsen shunt); 5cmH20
Options for oxygenating non-ventilated lung
- Insufflate O2 via suction catheter; beware of high pressure against bronchus
- Apply CPAP via separate circuit
- Discuss with surgeon RE: two lung ventilation
- Final option is to clamp PA however only option if pneumonectomy
Steps for going onto OLV
- Set FIO2 0.5-1.0
- Can use volume control or pressure control; if pressure, note Paw with 2 lung ventilation
- Clamp Y-connection to operative lung (non dependent), open sealing cap
- Correct isolation → Vt usually drops by ⅔
- If Paw excessive (>35) exclude mechanical causes
Bilateral thoracic procedures
- Increased risk of hypoxia due to supine position and alternating OLV