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Update on one-lung ventilation: the use of continuous positive airway pressure ventilation and positive end-expiratory pressure ventilation – clinical application

Grichnik, Katherine P; Shaw, Andrew

Current Opinion in Anesthesiology: February 2009 - Volume 22 - Issue 1 - p 23–30
doi: 10.1097/ACO.0b013e32831d7b41
Thoracic anesthesia: Edited By Javier Campos

Purpose of review The purpose of this review is to examine the evidence for and the clinical use of continuous positive airway pressure (CPAP) and positive end-expiratory pressure (PEEP) for the management of one-lung ventilation during thoracic surgery. CPAP and PEEP use are important as we are increasingly challenged with patients with less respiratory reserve and greater comorbidity leading to the need for greater clinical management and more interventions during one-lung ventilation for thoracic surgery to prevent perioperative complications.

Recent findings The focus of this article is on the most recent literature with selected classic articles. First, the supportive literature and rationale for application of PEEP, CPAP or both during thoracic surgery are reviewed, relative to the threats of hypoxemia, hyperoxia and mechanical lung injury. The second part of the article focuses on the clinical use of PEEP and CPAP. Algorithms for the application of CPAP and PEEP to patients both at risk and not at risk of acute lung injury are presented.

Summary CPAP and PEEP are useful not only to treat hypoxia and atelectasis as the consequence of one-lung ventilation, perhaps more importantly, also as part of a protective lung-ventilation strategy to ameliorate mechanical stress and prevent acute lung injury.

Division of Cardiothoracic Anesthesia and Critical Care Medicine, Duke University Medical Center, Durham, North Carolina, USA

Correspondence to Katherine Grichnik, MD, Professor of Anesthesia, Division of Cardiothoracic Anesthesia and Critical Care Medicine, Box 3094, Duke University Medical Center, Durham, NC 27710, USA Tel: +1 919 681 6893; fax: +1 919 681 8994; e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.