One-Lung Ventilation and Acute Lung Injury
As described elsewhere in this issue of International Anesthesiology Clinics, the pathophysiology of perioperative acute lung injury (ALI) is multifactorial and complex. Best practice for reduction of the incidence of ALI currently centers on minimization of iatrogenic risk factors. These iatrogenic risk factors can be related to ventilator-induced lung injury, such as volutrauma, barotrauma, and atelectrauma, or other nonventilator iatrogenic factors, such as fluid and blood administration. This chapter will focus on the specific conditions of thoracic surgery and/or one-lung ventilation (OLV), as pertaining to the iatrogenic risk of developing perioperative ALI and acute respiratory distress syndrome (ARDS). We will review the unique physiology of thoracic surgery and OLV, evolution of OLV strategies over the past century, the most recent and influential literature that has led to the current recommendations for OLV strategy, and describe the relation of fluid and blood administration to the development of perioperative ALI in thoracic surgery and OLV.