Single lung ventilation in patients undergoing lobectomy

The outcome of patients undergoing lobectomy will depend, in part, on preexistent lung disease and lung function. These patients often have chronic obstructive pulmonary disease (COPD) and reduced lung function. In addition, they will necessarily lose lung volume during the surgical procedure. Consequently, complications will depend on preoperative lung function, intraoperative management, and postoperative care. The first step in their management requires careful preoperative assessment and treatment of any reversible lung disease, such as infection and bronchospasm. The second step requires selection of the planned operative procedure. This likely depends on the anatomic distribution of the disease, the surgeon’s skills, and the surgeon’s experience. The third step involves intraoperative management with single lung ventilation resulting in collapse of the ipsilateral lung and ventilation of the contralateral lung to maintain gas exchange during the procedure. This ventilatory strategy necessarily results in atelectasis, produces abnormal gas exchange with possible hypoxemia and/or hypercapnia, and potentially causes overinflation of the contralateral lung (1,2). Therefore, during a single procedure, the patient is at risk for atelectrauma, volutrauma, and biotrauma (2). We will discuss these considerations in patients undergoing lobectomy and comment on the guideline “The Society for Translational Medicine: clinical practice guidelines for mechanical ventilation management for patients undergoing lobectomy” published in the Journal of Thoracic Disease (3)