Arterial oxygen desaturation during one-lung ventilation in a patient with segmental pulmonary infarction

A left thoracotomy for decortication of an infected haemothorax was performed on a 52-year-old man with a partially infarcted left lower lobe that occurred as a rare complication of a pulmonary venous embolus. Before the completion of surgery, after an uncomplicated 40 minutes of one-lung ventilatio...

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Bibliographic Details
Published in:Anaesthesia and intensive care 2005-12, Vol.33 (6), p.801-804
Main Authors: PFITZNER, J, LANCE, D. G, PEACOCK, M. J
Format: Article
Language:English
Subjects:
Anesthesia
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Blood Gas Analysis
Follow-Up Studies
Hemothorax - diagnostic imaging
Hemothorax - surgery
Humans
Intraoperative Complications - diagnosis
Intraoperative Complications - therapy
Male
Medical sciences
Middle Aged
Oxygen - blood
Oxygen Inhalation Therapy - methods
Pneumonectomy - adverse effects
Pneumonectomy - methods
Positive-Pressure Respiration - methods
Pulmonary Embolism - diagnostic imaging
Pulmonary Embolism - surgery
Risk Assessment
Thoracotomy - adverse effects
Thoracotomy - methods
Tomography, X-Ray Computed
Treatment Outcome
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Summary:A left thoracotomy for decortication of an infected haemothorax was performed on a 52-year-old man with a partially infarcted left lower lobe that occurred as a rare complication of a pulmonary venous embolus. Before the completion of surgery, after an uncomplicated 40 minutes of one-lung ventilation, the left lung was temporarily re-expanded to assess air leak. On the resumption of one-lung ventilation the SpO2 fell rapidly to 85%, despite apnoeic oxygenation of the non-ventilated lung. In the absence of evidence of double-lumen tube displacement, intra-pulmonary shunting as a consequence of impaired hypoxic pulmonary vasoconstriction in the newly expanded markedly pathological lung is considered the most likely mechanism.
ISSN:0310-057X
1448-0271
DOI:10.1177/0310057X0503300616