Clinical Report: Deterioration of Hypoxemia Associated with PEEP During OLV

Overview

This case study highlights a 55-year-old male who experienced severe hypoxemia during one-lung ventilation (OLV) that worsened after the escalation of positive end-expiratory pressure (PEEP).

Background

Perioperative hypoxemia during OLV is a significant challenge in thoracic surgery, often requiring immediate interventions. Understanding the dynamics of PEEP and its interaction with intracardiac shunts is crucial for effective management during OLV.

Data Highlights

No numerical data or trial data provided in the article.

Key Findings

• PEEP escalation from 5 to 10 cmH2O led to a decline in SpO2 from 88%-90% to 82%.
• Reduction of PEEP to 2 cmH2O resulted in rapid recovery of SpO2 to 96%-98%.
• Postoperative evaluation revealed an anatomical PFO and a small right-to-left shunt.
• Increased right-sided pressures relative to left-sided pressures can unmask pressure-dependent shunting.

Clinical Implications

Clinicians should consider intracardiac shunts as a reversible cause of hypoxemia when PEEP escalation worsens oxygenation.

Conclusion

This case underscores the importance of understanding the effects of PEEP in patients with PFO during OLV. Clinicians should consider reducing PEEP as a diagnostic and therapeutic measure when faced with paradoxical hypoxemia.

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