One-Lung Ventilation

Case Synopsis

A 72-year-old man is scheduled for robotic-assisted right upper lobe wedge resection for adenocarcinoma. His medical history is notable for stable coronary artery disease treated with coronary artery bypass grafting and a bare metal stent and hypertension treated with an angiotensin-converting enzyme (ACE) inhibitor. Preoperative pulmonary function testing reveals a forced expiratory volume in 1 second (FEV ₁ ) of 85% predicted, a diffusing capacity of 56% predicted, and a ventilation/perfusion (V/Q) scan showing 65% of perfusion to the right lung. After intubation with a left double-lumen tube, the patient is positioned laterally, and lung isolation is achieved after reconfirmation of tube placement with a bronchoscope. Within 5 minutes of lung isolation, the patient begins to desaturate, gradually reaching a nadir of 88% at 30 minutes despite initial maneuvers to improve oxygenation on one lung.