Case Report: Paradoxical worsening of hypoxemia with PEEP during one-lung ventilation: a case of pressure-dependent intracardiac shunting - Scorecard - MDSpire
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Case Report: Paradoxical worsening of hypoxemia with PEEP during one-lung ventilation: a case of pressure-dependent intracardiac shunting
Clinical Scorecard: Case Study: Deterioration of Hypoxemia Associated with PEEP During One-Lung Ventilation: An Instance of Pressure-Dependent Right-to-Left Intracardiac Shunting
At a Glance
Category
Detail
Condition
Key Mechanisms
Target Population
Patients undergoing thoracic surgery with potential patent foramen ovale (PFO) as a risk factor.
Care Setting
Key Highlights
PEEP escalation can paradoxically worsen oxygenation in patients with PFO.
A 55-year-old male experienced severe hypoxemia after PEEP was increased.
Reduction of PEEP led to rapid recovery of oxygen saturation.
Postoperative evaluation confirmed an anatomical PFO and right-to-left shunt.
Guideline-Based Recommendations
Diagnosis
Consider intracardiac shunt in patients with worsening hypoxemia during OLV.
Management
Reduce PEEP if oxygenation deteriorates after escalation.
Monitoring & Follow-up
Monitor oxygen saturation closely during PEEP adjustments.
Risks
Risk of pressure-dependent shunting in patients with occult PFO.
Patient & Prescribing Data
Adults undergoing thoracic surgery, particularly those with potential PFO.
PEEP should be titrated carefully, considering the risk of shunting.
Clinical Best Practices
Perform thorough preoperative assessments to identify potential PFO.
Use echocardiography judiciously to evaluate suspected shunts intraoperatively.
