Skip to main content
. 2019 Apr 11;20:213. doi: 10.1186/s13063-019-3208-8

Table 2.

Rescue strategies for intraoperative hypoxemia and hypercapnia

If hypoxemia occurs in the high PEEP group during TLV 1. Apply RM
2. Increase PEEP to 12 cmH2O and apply RM
3. Increase FIO2 in steps of 0.1 until 1.0
4. Consider stepwise decrease of PEEP down to 8 cmH2O
If hypoxemia occurs in the low PEEP group during TLV 1. Increase FIO2 in steps of 0.1 until 1.0
2. Apply RM
3. Increase PEEP to 6 cmH2O
4. Apply RM
5. Increase PEEP to 7 cmH2O
6. Apply RM
If hypoxemia occurs in the high PEEP group during OLV 1. Apply RM
2. Increase PEEP to 12 cmH2O and apply RM
3. Increase FIO2 in steps of 0.1 up to 1.0
4. Apply oxygen to the non-ventilated lung, consider using CPAP (see lung re-expansion maneuver) up to a pressure of 20 cmH2O, or selective oxygen insufflation via fiberscope
5. Consider stepwise decrease of PEEP of the ventilated lung to 8 cmH2O
6. Consider surgical intervention (e.g., clamping of the pulmonary artery by surgeon)
7. Consider administration of inhaled nitric oxide or prostacyclin, or intravenous almitrine (provided the drug is approved in your country/institution)
8. Switch to TLV
If hypoxemia occurs in the low PEEP group during OLV 1. Increase FIO2 in steps of 0.1 up to 1.0
2. Apply oxygen to the non-ventilated lung, consider CPAP therapy (re-expansion of the non-ventilated lung) up to a pressure of 20 cmH2O, or selective oxygen insufflation via fiberscope
3. Apply RM to the ventilated lung
4. Increase PEEP to 6 cmH2O
5. Apply RM to the ventilated lung
6. Increase PEEP to 7 cmH2O
7. Apply RM to the ventilated lung
8. Consider surgical intervention (e.g., clamping of the pulmonary artery by surgeon)
9. Consider administration of inhaled nitric oxide or prostacyclin, or intravenous almitrine (provided the drug is approved in your country/institution)
10. Switch to TLV
If hypercapnia (PaCO2 > 60 mmHg) with respiratory acidosis (pHa < 7.20) occurs during OLV, these steps are applied in the high and low PEEP groups 1. Increase the respiratory rate (maximum 30/min, while minimizing intrinsic PEEP)
2. Increase VT stepwise up to 7 mL/kg PBW
3. Switch to TLV

RM recruitment maneuver, PEEP positive end-expiratory pressure, TLV two lung ventilation, FIO2 inspiratory fraction of oxygen, OLV one lung ventilation, CPAP continuous positive airway pressure, PaCO2 arterial partial pressure of carbon dioxide, pHa arterial pH value, VT tidal volume, PBW predicted body weight