OnExamination FRCA Final (Updated Feb 2023) (PDF)

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Demo Question Which one of the following options is an absolute indication for adult one-lung ventilation?    To assist with surgical access for an oesophagectomy   To control the distribution of ventilation in a patient with a bronchopleural fistula    To enable better surgical access for mediastinal mass excision    To facilitate surgical access for an upper lobectomy    To improve surgical access for video-assisted thoracoscopic surgery   Key Learning Point 
There are absolute and relative indications for one lung ventilation. Whilst in most cases the indications to improve surgical access are highly desirable, they are not considered absolute. Explanation There are absolute and relative indications for one-lung ventilation. In most cases the indications to improve surgical access are highly desirable, they are not considered absolute. Absolute indications include:

Isolation of a healthy lung to prevent contamination or damage from a lung abscess or pulmonary haemorrhage.
Control of the distribution of ventilation to prevent baro- or volutrauma of damaged lung tissue (bronchopleural fistula, major cyst or bulla, bronchial trauma.
Facilitation of single lung lavage

Relative indications include the enabling of surgical access for thoracic aortic surgery, lung resection, minimally invasive cardiac surgery, video-assisted thoracoscopic surgery (VATS), oesophageal surgery and mediastinal mass resection.