Dependent Lung Pulmonary Artery Hypoplasia as a Cause of Hypoxia during One-lung Ventilation
Bibliographic record
Abstract
Hypoxemia remains a well-described occurrence during one-lung ventilation.1 We recently observed unexpected refractory hypoxemia during one-lung ventilation in a previously healthy nonsmoking 30-yr-old female undergoing left thoracotomy in the right lateral decubitus position to facilitate complex descending aorta to left subclavian/carotid artery bypass grafting to treat upper limb and cerebral ischemia resulting from Takayasu’s arteritis. Despite endotracheal suctioning, reconfirmation of optimal bronchial blocker positioning, optimizing the fraction of inspired oxygen, and using both dependent lung positive end-expiratory pressure and nondependent lung continuous positive airway pressure,2 the Pao2 remained ~50 mmHg. No intracardiac shunt was seen on transesophageal echocardiography. Only intermittent two-lung ventilation temporarily corrected the hypoxemia. A postoperative computed tomography angiogram three-dimensional reconstruction (panel A) was performed to evaluate the vascular reconstruction and showed a hypoplastic right pulmonary artery (10 mm diameter; panel B) compared to a normal left pulmonary artery (19 mm diameter; panel C). We speculate that this hypoplasia resulted in enhanced shunting to the nondependent, nonventilated lung; this is a previously unreported potential cause for one-lung ventilation hypoxemia. Although pulmonary hypoplasia is estimated to occur in only 1:200,000 of the population, consideration should be given to reviewing the routinely acquired preoperative computed tomography scan to assess for pulmonary artery size differential as a rare potential risk factor for hypoxemia during one-lung ventilation. If present, anticipation of an increased risk for hypoxemia should prompt rapid escalation of adjunct therapies (i.e., positive end-expiratory pressure; continuous positive airway pressure; two-lung ventilation, with consideration to conversion of a thoracoscopic technique to open thoracotomy). Extracorporeal membrane oxygenation is also a potential option.The authors declare no competing interests.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".