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Background <p>Pulmonary atelectasis during one-lung ventilation (OLV) can cause intraoperative hypoxemia and is a risk factor for postoperative pulmonary complications (PPCs).</p> Objectives <p>We hypothesized that patients whose hypoxemia improves with recruitment maneuvers (RMs) have atelectasis-related hypoxemia and a higher risk of PPCs compared to those with hypoxemia unresponsive to RMs.</p> Design <p>Retrospective and observational study.</p> Settings <p>Single-entry study conducted in a University Hospital.</p> Patients <p>Adults patients (<i>n</i> = 195) with elective pulmonary lobectomy.</p> Main outcome measures <p>Between April 2022 and March 2023, all thoracic surgergy patients were classified into three groups: no intraoperative hypoxemia, hypoxemia responsive to RMs, and hypoxemia non-responsive to RMs. Postoperative outcomes were compared among groups, including incidence of respiratory distress, pneumonia, and RALE scores.</p> Results <p>Patients responsive to RMs had significantly higher rates of early (Day 0–4) respiratory distress (21.4% vs. 0% vs. 8.7%; <i>p</i> = 0.04) and late (Day 5–7) pneumonia (28.6% vs. 9% vs. 7%; <i>p</i> &lt; 0.001). Non-responders showed higher intraoperative airway pressures and higher RALE scores on Day 1, which normalized by Day 3. No significant differences in mechanical ventilation duration or ICU stay were observed.</p> Conclusion <p>Patients with hypoxemia responsive to RMs during OLV are at increased risk of PPCs, particularly respiratory distress and pneumonia, suggesting that intraoperative atelectasis is a major contributor. Identifying the hypoxemia profile could guide tailored perioperative strategies to minimize PPCs in these high-risk patients.</p>

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Postoperative pulmonary complications and response to recruitment maneuvers during hypoxemia in one lung ventilation

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月24日

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  • Bélaid Bouhemad,
  • Eléana Rogard,
  • Ophélie Dransart-Rayé,
  • Pierre-Benoit Pages,
  • Maxime Nguyen,
  • Pierre-Grégoire Guinot

摘要

Background

Pulmonary atelectasis during one-lung ventilation (OLV) can cause intraoperative hypoxemia and is a risk factor for postoperative pulmonary complications (PPCs).

Objectives

We hypothesized that patients whose hypoxemia improves with recruitment maneuvers (RMs) have atelectasis-related hypoxemia and a higher risk of PPCs compared to those with hypoxemia unresponsive to RMs.

Design

Retrospective and observational study.

Settings

Single-entry study conducted in a University Hospital.

Patients

Adults patients (n = 195) with elective pulmonary lobectomy.

Main outcome measures

Between April 2022 and March 2023, all thoracic surgergy patients were classified into three groups: no intraoperative hypoxemia, hypoxemia responsive to RMs, and hypoxemia non-responsive to RMs. Postoperative outcomes were compared among groups, including incidence of respiratory distress, pneumonia, and RALE scores.

Results

Patients responsive to RMs had significantly higher rates of early (Day 0–4) respiratory distress (21.4% vs. 0% vs. 8.7%; p = 0.04) and late (Day 5–7) pneumonia (28.6% vs. 9% vs. 7%; p < 0.001). Non-responders showed higher intraoperative airway pressures and higher RALE scores on Day 1, which normalized by Day 3. No significant differences in mechanical ventilation duration or ICU stay were observed.

Conclusion

Patients with hypoxemia responsive to RMs during OLV are at increased risk of PPCs, particularly respiratory distress and pneumonia, suggesting that intraoperative atelectasis is a major contributor. Identifying the hypoxemia profile could guide tailored perioperative strategies to minimize PPCs in these high-risk patients.