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Published on: December 5, 2025
[Effect of one lung ventilation preconditioning on oxygenation during pediatric video-assisted thoracoscopic surgery]
Guo-Qiang Zhang1, Jing Ye, Jun-Yong Chen
1Department of Anesthesiology, 3Department of Cardiothoracic Surgery, Guangzhou Women and Children's Medical Center of Guangzhou Medical University, Guangzhou 510623, China.
Insights
One lung ventilation (OLV) preconditioning effectively maintains oxygenation during pediatric video-assisted thoracoscopic surgeries (VATS). Longer procedures increase the need for postoperative ventilation and hospital stay.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Thoracic Surgery
Background:
- Pediatric video-assisted thoracoscopic surgery (VATS) often requires one lung ventilation (OLV).
- Maintaining adequate oxygenation during OLV in children is crucial for patient safety and surgical outcomes.
Purpose of the Study:
- To evaluate the impact of a specific OLV preconditioning protocol on perioperative oxygenation in pediatric VATS.
- To identify factors associated with prolonged ventilation and hospital stay in this patient population.
Main Methods:
- A prospective study involving 171 children undergoing various VATS procedures.
- Implementation of a preconditioning protocol involving sequential OLV and two lung ventilation (TLV) using a pediatric endobronchial blocker.
- Application of positive end-expiratory pressure (PEEP) and adjustment of ventilation strategies based on intraoperative SpO2 levels.
Main Results:
- OLV preconditioning facilitated good surgical conditions in most cases (160/171).
- Acceptable oxygen saturation was achieved in the majority of patients (166/171).
- Hypoxemia necessitated conversion to intermittent TLV in a small number of patients, particularly in the empyema and esophageal disease groups.
Conclusions:
- OLV preconditioning is a viable strategy for maintaining acceptable oxygenation during pediatric VATS.
- Extended operative times and OLV duration correlate with increased postoperative ventilation requirements and longer hospital lengths of stay (LOS).
Objective:
To observe the effect of one lung ventilation (OLV) preconditioning on perioperative oxygenation during pediatric video-assisted thoracoscopic surgeries (VATS).
Methods:
A total of 171 children aged 5 days to 11 years underwent VATS for empyema dissection and abscess excisions (n=55), mediastinal tumor resection (n=34), repair of the diaphragmatic hernia or diaphragmatic plication (n=21), pulmonary lobectomy or biopsy (n=43), or esophageal disease (n=18). Of these patients, 127 were younger than 3 years of age. A 5-Fr pediatric endobronchial blocker was used for OLV with a delivered inspired oxygen fraction (FiO(2)) of 1.0. After lateral decubitus, a sequential protocol of a 5- to 8-min OLV preconditioning and a 5-min two lung ventilation (TLV) was performed followed by OLV again before incision for VATS. In cases of a SpO(2)<95% without malposition of the blocker during OLV, a 5 cm H(2)O positive end expiratory pressure was applied; TLV was maintained for a SpO(2)<90%.
Results:
OLV provided good surgical conditions in 160 cases. Acceptable saturations were achieved in 166 cases during OLV. In 2 cases in empyema group and 3 in esophageal disease group, the ventilation protocol was converted to intermittent TLV during the operation due to hypoxemia. In esophageal disease group, the procedure and OLV duration, postoperative ventilation time and length of stay (LOS) were the longest among the groups, and the number of cases developing postoperative atelectasis was greater than that in diaphragmatic hernia and pulmonary disease groups. In empyema and esophageal disease groups, the oxygenation index (PaO(2)/FiO(2)) after total collapse of the lung in OLV and after extubation were lower than that in mediastinal tumor group (P<0.05 or 0.01).
Conclusion:
A OLV preconditioning can maintain an acceptable oxygenation during pediatric OLV. A longer procedure and OLV duration is associated with a prolonged postoperative length of ventilation and LOS.
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