Single Lung Ventilation

[Hook_EM]

I know there's literature in thoracic surgery, however, is there any general rule or data for single lung ventilation for a patient that had a pneumonectomy? Is it as simple as it sounds? Just cut your tidal volumes in half? So instead of 8ml/kg ideal body weight i'd use 4ml? Or something around there? Thanks.

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[Hernandez]

That's where I start and adjust from there. Some need more some need less.

 

[tartesos]

I saw a patient with unintentional single lung ventilation yesterday....


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[Hernandez]

I saw a patient with unintentional single lung ventilation yesterday....


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**** happens

 

[Colorado outliers]

I know there's literature in thoracic surgery, however, is there any general rule or data for single lung ventilation for a patient that had a pneumonectomy? Is it as simple as it sounds? Just cut your tidal volumes in half? So instead of 8ml/kg ideal body weight i'd use 4ml? Or something around there? Thanks.

Yes 4 ml/kg is a good place to start. In many patients the remaining lung will have expanded to varying degrees. In my (limited) experience, they can tolerate higher volumes without excessive airway pressure due to this expansion. In a patient w pneumonia you may require volumes higher than 4 ml/kg

 

[CopaceticOne]

Instead of volume control, why not just do pressure control and see where the tidal volumes end up? Realistically, pressure control will give the safest start, since you won't be able to cause barotrauma if your Pmax is 20.

 

[Mad Jack]

Instead of volume control, why not just do pressure control and see where the tidal volumes end up? Realistically, pressure control will give the safest start, since you won't be able to cause barotrauma if your Pmax is 20.

You run the risk of hypoventilation though, particularly if your RT gets lazy with their alarm settings. Back when I was a neb jockey I preferred actually using flow-volume loops on these patients, starting at 4 cc/mg, then analyzing the loop to look for braking. If you've got a break, consider pressure ventilation, if not, titrate RR to maintain CO2 in the normal range. Most of my single lung patients had RRs in the high 20s/low 30s. Make sure to check for autoPEEP, as your I:E ratios can start to hit close to 1:1 as patient RRs get higher if you're not mindful of flow rates and pulmonary mechanics

 

[deleted547339]

Instead of volume control, why not just do pressure control and see where the tidal volumes end up? Realistically, pressure control will give the safest start, since you won't be able to cause barotrauma if your Pmax is 20.

That’s simply not true.

 

[Hernandez]

That’s simply not true.

It is until it isn’t or when it possibly is or if your attending is an dingus.

 

[CopaceticOne]

That’s simply not true.

Please elaborate

 

[deleted547339]

Please elaborate

Volutrauma and barotrauma are intimately related but not entirely colinear. Large tidal volumes at relatively low Pplats can still be harmful. Then there’s the whole independent discussion on drive pressure.