Positive End-Expiratory Pressure (PEEP), Tidal Volume, or Alveolar Recruitment: Which One Does Matter in One-Lung Ventilation?

Abstract

Purpose of Review This review attempts to focus on protective ventilation approaches during one-lung ventilation (OLV) and will summarize recent findings. Recent Findings Recent studies have demonstrated the importance of low tidal volume (low TV) and reduced driving pressure during OLV. Along with low TV, correct use of positive end-expiratory pressure (PEEP) seems to have a vital role in terms of protecting the ventilated lung. PEEP decremental trial and the use of electrical impedance tomography are prominent techniques for individualizing the PEEP. The use of alveolar recruitment maneuvers (ARMs) is furthermore recommended. Nevertheless, there are several studies published considering negative effects of ARM. Summary Although small tidal volumes are highly recommended during OLV, it is not possible for low TV to be beneficial unless an optimal PEEP is applied. Use of ARM is still under debate. Yet, it seems to be the only way for preventing injurious tidal recruitment, which is known to be harmful to the lungs.