Management of Refractory Hypoxemia in Onelung ventilation applying CPAP through a Bronchial Blocker to Non-operated Lobes on the Operative Side in Combination with a Double Lumen Tube: A Case Report
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Abstract
Abstract: One-lung ventilation (OLV) is standard during thoracic surgery, but maintaining adequate oxygenation can be particularly challenging in patients with prior contralateral lobectomy. We report the case of a 44-year-old woman undergoing uniportal video-assisted thoracic surgery (uVATS) right upper lobectomy after a previous left upper lobectomy. Severe hypoxemia occurred during OLV despite maximal ventilatory adjustments and the application of conventional continuous positive airway pressure (CPAP) to the operative lung, which impaired surgical exposure. As a rescue strategy, a bronchial blocker was inserted through a left-sided double-lumen tube (DLT) into the right bronchus intermedius, enabling selective CPAP delivery to the right middle and lower lobes while maintaining collapse of the right upper lobe. This approach successfully restored oxygenation without interfering with the surgical field. This case illustrates that the combined use of a DLT and bronchial blocker can provide an effective and safe solution for refractory hypoxemia, and can be considered as a rescue technique in complex thoracic procedures after contralateral resections.
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| Authors | Al Chammas, Monique |
| Journal | Frontiers in surgery |
| Year | Year not found |
| DOI |
10.3389/fanes.2026.1700476
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| Keywords | Keywords not found |
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