Purpose of review: Hypoxemia during one-lung ventilation (OLV) has become less common; however, it may still occur in about 10% of cases. We review recent developments which may affect the incidence and treatment of hypoxemia during OLV.
Recent findings: Changes in surgical techniques are affecting oxygenation during OLV. The increased use of the supine position may adversely affect the prevalence of hypoxemia, whereas the increased application of thoracoscopic techniques is limiting the treatment options. Treatment options such as global or selective recruitment maneuvers and drug effects of dexmedetomidine and epoprostenol on arterial oxygenation during OLV are discussed. Capnometry prior to, or early during OLV, may in fact be able to predict the degree of hypoxemia during OLV. Persistent controversies surrounding the effect of epidural anesthesia, ventilatory modalities and gravity are reviewed.
Summary: Interesting concepts have emerged from case reports and small studies on the treatment and prediction of hypoxemia during OLV. Definitive studies on the most effective ventilatory mode remain elusive. End-organ effects of OLV are an exciting new concept that may shape clinical practice and research going forward.