One lung vent: O2 desat Rx

One lung ventilation-Hypoxia treatment

1. FiO₂ 100%
2. Recheck positioning of double-lumen tube for correct placement using fiberoptic bronchoscope.
3. Suction both lumens of double-lumen tube for secretions or mucous plugs
4. 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.
5. 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.
6. 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.
7. Ultimately may need to ligate or clamp the ipsilateral pulmonary artery (i.e., during pneumonectomy) so that all blood flow directed to ventilated lung.
8. Last resort (as in patient undergoing a lung transplant) may need to go on cardiopulmonary bypass to improve oxygenation.