One-lung ventilation: Indications

One-lung ventilation (OLV), or lung isolation, is frequently employed for intrathoracic surgical procedures and is also used in situations where pathology may affect one lung but not the other. Lung isolation may be accomplished by a number of methods including double lumen endotracheal tubes, placement of a bronchial blocker through a single lumen endotracheal tube, and single lumen endobronchial tubes (or advancement of a single lumen endotracheal tube to an endobronchial position.

Slinger describes three general categories for classification of indications for lung isolation.

1. Surgical Exposure
2. Protection of contralateral lung from injury or pathology
3. Maintenance of continuous ventilation during differential lung ventilation (bronchopleural fistula, history of single lung transplant with severe obstructive disease of native lung, or large bleb/bullae, etc)

Barash further divides indications for OLV absolute or relative

Absolute Indications

1. Lung isolation to prevent damage or contamination of healthy lung
   • Pulmonary hemorrhage or lung abscess
2. Control of Distribution of Ventilation
   • Bronchopleural fistula, bronchial disruption from trauma, or major cyst or bulla
3. Single Lung Lavage
   • As during treatment for pulmonary alveolar proteinosis or cystic fibrosis
4. Surgical Exposure for Video-assisted thoracoscopic surgery (VATS)

Relative Indications

Surgical Exposure (Strong)

1. Thoracic Aortic Aneurysm
2. Pneumonectomy
3. Lung Volume Reduction
4. Minimally Invasive Cardiac Surgery
5. Upper Lobectomy

Surgical Exposure (Weak)

1. Esophageal surgery
2. Middle and lower lobectomy
3. Mediastinal Mass Resection
4. Bilateral Sympathectomies