A 72-year-old patient with FEV1/FVC 0.58 and FEV1 45% predicted undergoes thoracotomy with right upper lobectomy. Which intraoperative ventilation strategy best reduces postoperative pulmonary complications?
- A Tidal volume 10 mL/kg IBW with PEEP 0 cmH₂O during one-lung ventilation
- B High FiO₂ (1.0) throughout to avoid hypoxaemia during one-lung ventilation
- C Lung-protective ventilation: TV 4–6 mL/kg IBW, PEEP 5–8 cmH₂O, recruitment manoeuvres; FiO₂ as low as feasible ✓
- D Intermittent positive pressure breath holds (Valsalva manoeuvres) to prevent atelectasis
Correct answer: C. Lung-protective ventilation: TV 4–6 mL/kg IBW, PEEP 5–8 cmH₂O, recruitment manoeuvres; FiO₂ as low as feasible
Explanation
Lung-protective ventilation during one-lung ventilation (TV 4–6 mL/kg ideal body weight, moderate PEEP 5–8 cmH₂O, peak airway pressure <35 cmH₂O, driving pressure <15 cmH₂O) reduces ventilator-induced lung injury and postoperative pulmonary complications in thoracic surgery. High tidal volumes cause volutrauma/barotrauma to the dependent lung. Sustained FiO₂ 1.0 increases risk of absorption atelectasis and oxygen toxicity; permissive hypoxaemia (SpO₂ >88–90%) is acceptable. Recruitment manoeuvres are useful but Valsalva manoeuvres are not a standard strategy.
Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.
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