Severe hypoxemia during carinal resection under one-lung ven
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Thoracic surgery is generally performed in the lateral position with the non-dependent lung collapsed to improve surgical exposure, and one-lung ventilation (OLV) is applied to the dependent lung. During OLV, more of the pulmonary blood flow is distributed to the dependent ventilated lung, improving the match of ventilation with perfusion and oxygenation. Conversely, if OLV is applied to the non-dependent lung, even though it is clinically rare, the increased perfusion to the dependent non-ventilated lung might cause severe hypoxemia. Therefore, the strategy to reduce shunt flow is required for treatment of the hypoxemia.

This article reports a case of severe hypoxemia during carinal resection under OLV of a non-dependent lung. In this case, OLV had to be applied to the non-dependent lung in the lateral position because the bronchus of the non-dependent lung was anastomosed with the trachea, whereas the bronchus of the dependent lung had already been resected for carinal resection. The subsequent hypoxemia resulting from the shunt flow to the dependent non-ventilated lung was treated successfully by ligating the pulmonary artery of the dependent lung...

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