One-Lung Ventilation in Anesthesia

The purpose of one-lung ventilation (OLV) is to provide a good surgical exposure of a collapsed lung while ensuring adequate gas exchange with the other. Currently, double-lumen tubes (DLTs) or bronchial blockers (BBs) are used to obtain it. The separation of the lungs today means a completed “anatomical” sealing with DLTs, and the isolation of the lung means a “functional” sealing with BBs [1–3]. In the first case, there are some absolute indications in which a protective strategy for the contralateral lung is needed, including life-threatening conditions such as massive bleeding, pneumonia with pus, and bronchopleural and bronchocutaneous fistulae, since they offer a low-resistance pathway during positive pressure ventilation, as well as giant unilateral bullae that may blow. Some surgical interventions as sleeve pneumonectomy or bronchopulmonary lavage for alveolar proteinosis or cystic fibrosis still require lung separation. In all the other situations, in which lung separation is a relative indication, lung isolation could be used [4, 5].