One-lung ventilation in pediatric patients: A clinically focused narrative review.

Successful institution and management of one-lung ventilation in pediatric patients requires knowledge of the unique airway anatomy and respiratory physiology of these patients, options for lung isolation, and awareness of common intra-procedure complications. Pediatric patients are more vulnerable to changes in ventilation as compared to adults due to anatomic and physiologic differences in their respiratory systems. There are several methods for lung isolation available to the clinician, the selection of which depends on a variety of factors including size and age of the patient, pathology involved, and the needs of the surgeon. Each method comes with its own potential pitfalls, which the clinician must be aware of in order to anticipate and manage common complications. Ventilation strategies during one-lung ventilation may also differ based on the aforementioned factors. To date, there is little credible evidence to support a clear benefit of one ventilation strategy over another, so choice can be made on an individual patient basis. The approach to resumption of two-lung ventilation and extubation are also important steps in the perioperative management of these patients.