The online version of this article (doi:10.1007/s40140-014-0057-6) contains supplementary material, which is available to authorized users.
Alf Kozian and Thomas Schilling declare that they have no conflict of interest.
This article does not contain any studies with human or animal subjects performed by any of the authors.
The thoracic surgical patient is at special risk for increased postoperative pulmonary complications, such as atelectasis, impaired lung function and pneumonia, as well as acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) with high mortality after lung resections. One-lung ventilation (OLV) induces proinflammatory responses especially in the ventilated lung, based on mechanical stress, persistent hyperperfusion, increased gas content and ventilation to perfusion mismatching. ALI may occur, even in previously healthy lungs. Ventilation management can cause and exacerbate but also attenuate ALI after OLV. Protective ventilatory approaches can improve the outcome by minimizing lung damage. However, ventilation with lower tidal volumes during OLV does not completely abolish alveolar inflammation. The present review addresses the effects of OLV and their role in ventilator-induced lung injury. Lung protective strategies to one-lung ventilation that additionally include reduction of cyclic alveolar recruitment, PEEP ventilation, limitation of inspired oxygen and pharmacological preconditioning by volatile anesthetics are discussed.
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Dynamic computed tomography scan during OLV with V T = 10 ml/kg without preceding ARM. Please note the shearing and stretching of the most dependent parts in the lower ventilated lung (AVI 10991 kb)40140_2014_57_MOESM1_ESM.avi
Dynamic computed tomography scan during OLV with V T = 5 ml/kg, PEEP 5 cmH 2O after application of an ARM ( P AW = 40 cmH 2O for 10 s). Please note the homogeneous lung tissue distribution and the obvious decrease of cyclic recruitment in the dependent ventilated lung (AVI 14,303 kb)
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