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 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.
Pfitzner
J
J
Department of Anaesthesia and Thoracic Surgery Unit, The Queen Elizabeth Hospital, Woodville, Adelaide, South Australia.
Lance
D G
DG
Peacocks
M J
MJ
D001784:Blood Gas Analysis; D005500:Follow-Up Studies; D006491:Hemothorax / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood*; D010102:Oxygen Inhalation Therapy / Q000379:methods*; D011013:Pneumonectomy / Q000009:adverse effects* / Q000379:methods; D011175:Positive-Pressure Respiration / Q000379:methods*; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000601:surgery*; D018570:Risk Assessment; D013908:Thoracotomy / Q000009:adverse effects / Q000379:methods; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D010100:Oxygen