From the list below, please select which one is not a classical “absolute indication” for one lung ventilation.
a) Upper Lobectomy
b) Large unilateral bullae
c) Bronchoalveolar lavage for alveolar proteinosis
d) Unilateral airway bleeding
e) Pneumonectomy
Answer a.
The use of OLV for upper lobectomy depends on surgeon preference, but is not mandatory. On the other hand, pneumonectomy patients do require OLV. Patients with differential lung compliance (such as those with large bullae unilaterally) are at risk of rupture with pneumothorax, and this risk may be reduced by the utilization of different ventilation strategies for each lung. Finally, conditions where lung contamination may be life threatening (as in pulmonary hemorrhage or alveolar proteinosis) usually require OLV. Note that these historical “absolutes” generally all have exceptions reported.