Anaes · Thoracic anaesthesia
One-lung ventilation physiology and the hypoxaemia management algorithm
Also known as OLV hypoxaemia · One-lung ventilation algorithm · Double-lumen tube hypoxaemia
OLV shunt physiology, hypoxic pulmonary vasoconstriction, DLT versus bronchial blocker principles, lung-protective OLV settings, and the stepwise hypoxaemia algorithm for fellowship exams.
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Target exams
Red flags
- Always confirm DLT/BB position with fibreoptic bronchoscopy when hypoxaemia occurs.
- Volatiles inhibit HPV dose-dependently — consider TIVA if refractory hypoxaemia.
- Keep peak airway pressures protective; do not stack volutrauma.
- Left-sided DLT preferred for margin of safety in most resections.
- Anterior mediastinal mass is a different disaster — do not treat as simple OLV hypoxaemia.
Meet the patient
A 68-year-old is in the lateral position for a right upper lobectomy. Five minutes after you isolate the lung, the saturation falls to 87 percent. The surgeon is asking for the field. Your registrar reaches for the volatile dial to deepen.[1]
The two questions every OLV crisis hangs on: is the tube still where you put it, and have you told the surgeon? Most hypoxaemia is malposition or secretions, and climbing volatile to deepen a hypoxic patient is the wrong first move.[1]
References1ShowHide
- [1]Licker M, Hagerman A, Jeleff A, Schorer R, Ellenberger C The hypoxic pulmonary vasoconstriction: From physiology to clinical application in thoracic surgery. Saudi Journal of Anaesthesia, 2021.PMID 34764832