Objective:

To report a case of refractory hypoxemia during one-lung ventilation and the use of a bronchial blocker with CPAP as a rescue strategy, highlighting its significance in clinical practice.

Key Findings:

• Severe hypoxemia occurred during one-lung ventilation despite maximal ventilatory adjustments, underscoring the challenge in such cases.
• The use of a bronchial blocker allowed for selective CPAP delivery without impairing surgical exposure, demonstrating a novel approach.
• This combined approach effectively restored oxygenation in a complex thoracic procedure, suggesting its potential as a standard practice.

Interpretation:

The case demonstrates that using a bronchial blocker with CPAP can be an effective rescue strategy for refractory hypoxemia during thoracic surgeries in patients with prior lung resections, compared to traditional methods.

Limitations:

• The study is based on a single case report, limiting generalizability.
• No intraoperative compliance measurements were recorded.
• Lack of long-term follow-up data on patient outcomes.

Conclusion:

The combined use of a double-lumen tube and bronchial blocker is a viable option for managing refractory hypoxemia in thoracic surgery patients with previous lobectomies, warranting further investigation in larger studies.