One lung ventilation-Hypoxia treatment
- FiO2 100 %
- Recheck positioning of double-lumen tube for correct placement using fiberoptic bronchoscope.
- Suction both lumens of double-lumen tube for secretions or mucous plugs
- May need to notify surgeons to stop and return to two-lung ventilation. Or at least ask for periodic reinflation/recruitment maneuvers of the nondependent collapsed lung.
- Consider CPAP (5-10 cm H2O) to the collapsed, nondependent lung. This maintains patency of the nondependent alveoli allowing gas exchange to occur and will divert blood away from the collapsed lung.
- Consider PEEP (5-10 cm H2O) to the ventilated, dependent lung. This can increase FRC and improve gas exchange in the dependent lung. However, high levels can increase PVR and shunt blood flow to the nondependent lung.
- Ultimately may need to ligate or clamp the ipsilateral pulmonary artery (i.e., during pneumonectomy) so that all blood flow directed to ventilated lung.
- Last resort (as in patient undergoing a lung transplant) may need to go on cardiopulmonary bypass to improve oxygenation.