Lung Isolation Anesthesia

Excerpt

Lung isolation describes either anatomic or physiologic separation of one lung from the other using an advanced airway device, typically a bronchial blocker (BB) or double-lumen endotracheal tube (DLT). Anatomical lung isolation separates a diseased lung and prevents it from contaminating the healthy lung. For example, in the case of whole lung lavage, anatomical lung isolation is used to avoid spillage of blood or pus from the diseased lung to the healthy lung. Physiological lung separation ventilates each lung as an independent unit and may be indicated when unilateral lung pathology requires differential ventilatory parameters for each lung. One-lung ventilation (OLV) is the ability to ventilate one lung while allowing the other to collapse either to facilitate surgical exposure or to manage individual disease states. The deflation of one lung can establish an immobile surgical field and create space within the thorax, allowing access to anatomical structures.

A practitioner with advanced airway training (i.e., anesthesiologist or intensivist) should place the DLT or BB. Extensive knowledge of pulmonary physiology is essential for managing lung isolation, particularly during periods of OLV, which can often be complicated by hypoxia. When used to facilitate surgery, lung isolation requires clear communication between the surgical and anesthesiology teams to prevent and manage complications. In the intensive care setting, nurses and respiratory therapists must be aware of the physiologic consequences of differential or one-lung ventilation and detect changes in the patient's condition that may indicate a problem with lung isolation.