Arterial Oxygenation and Management of Hypoxemia During VATS

Abstract

The volume and complexity of thoracic procedures performed with a thoracoscopic approach are steadily increasing. Surgical exposure is paramount for thoracoscopic procedures and requires meticulous lung isolation. In this review, the physiological adaptive mechanisms that occur during one-lung ventilation (OLV) are discussed. Factors that predict the occurrence of hypoxemia during OLV and a structured approach to the treatment of hypoxemia are outlined. Hypoxemia management is formulated in an escalating fashion, from basic solutions to common problems, all the way to advanced manipulations of shunt fraction and partial ventilation techniques.