BACKGROUND One-lung ventilation in children remains a specialized practice with low case numbers even at tertiary centers, preventing an assessment of best practices. The authors hypothesized that certain case factors may be associated with a higher risk of intraprocedural hypoxemia in children undergoing thoracic surgery and one-lung ventilation. METHODS The Multicenter Perioperative Outcomes database and a local quality improvement database were queried for documentation of one-lung ventilation in children 2 months to 3 yr of age inclusive between 2010 and 2020. Patients undergoing vascular or other cardiac procedures were excluded. All records were reviewed electronically for the presence of hypoxemia, oxygen saturation measured by pulse oximetry (Spo2) less than 90% for 3 min or more continuously, and severe hypoxemia, Spo2 less than 90% for 5 min or more continuously during one-lung ventilation. Records were also assessed for hypercarbia, end-tidal CO2 greater than 60 mmHg for 5 min or more or a Paco2 greater than 60 on arterial blood gas. Covariates assessed for association with these outcomes included age, weight, American Society of Anesthesiologists (Schaumburg, Illinois) Physical Status 3 or greater, duration of one-lung ventilation, preoperative Spo2 less than 98%, bronchial blocker versus endobronchial intubation, left operative side, video-assisted thoracoscopic surgery, lower tidal volume ventilation (tidal volume less than or equal to 6 ml/kg plus positive end expiratory pressure greater than or equal to 4 cm H2O for more than 80% of the duration of one-lung ventilation), and type of procedure. RESULTS Three hundred six cases from 15 institutions were included for analysis. Hypoxemia and severe hypoxemia occurred in 81 of 306 (26%) patients and 56 of 306 (18%), respectively. Hypercarbia occurred in 153 of 306 (50%). Factors associated with lower risk of hypoxemia in multivariable analysis included left operative side (odds ratio, 0.45 [95% CI, 0.251 to 0.78]) and bronchial blocker use (odds ratio, 0.351 [95% CI, 0.177 to 0.67]). Additionally, use of a bronchial blocker was associated with a reduced risk of severe hypoxemia (odds ratio, 0.290 [95% CI, 0.125 to 0.62]). CONCLUSIONS Use of a bronchial blocker was associated with a lower risk of hypoxemia in young children undergoing one-lung ventilation. EDITOR’S PERSPECTIVE

中文翻译：

---

接受单肺通气的幼儿的低氧血症：一项回顾性队列研究。

背景 即使在三级中心，儿童的单肺通气仍然是一种特殊的做法，病例数很少，因此无法评估最佳做法。作者假设某些病例因素可能与接受胸外科手术和单肺通气的儿童术中低氧血症的风险较高有关。方法 查询多中心围手术期结果数据库和当地质量改进数据库，以获取 2010 年至 2020 年间 2 个月至 3 岁（含）儿童的单肺通气记录。排除接受血管或其他心脏手术的患者。以电子方式审查所有记录是否存在低氧血症、脉搏血氧仪 (Spo2) 测量的血氧饱和度低于 90% 持续 3 分钟或更长时间，以及严重的低氧血症，单肺通气期间血氧饱和度低于 90% 持续 5 分钟或更长时间。还评估了高碳酸血症、潮气末 CO2 大于 60 mmHg 5 分钟或更长时间或动脉血气 Paco2 大于 60 的记录。评估与这些结果相关的协变量包括年龄、体重、美国麻醉医师协会（伊利诺伊州绍姆堡）身体状况 3 或更高、单肺通气持续时间、术前 Spo2 小于 98%、支气管阻滞剂与支气管内插管、左侧手术侧, 电视胸腔镜手术, 低潮气量通气（潮气量小于或等于 6 ml/kg 加上呼气末正压大于或等于 4 cm H2O 超过 80% 的单肺通气持续时间） , 和程序类型。结果共纳入来自15个机构的306个病例进行分析。306 名患者中的 81 名（26%）和 306 名患者中的 56 名（18%）分别发生了低氧血症和严重低氧血症。306 人中有 153 人发生高碳酸血症（50%）。多变量分析中与低氧血症风险较低相关的因素包括左侧手术（优势比，0.45 [95% CI，0.251 至 0.78]）和支气管阻滞剂的使用（优势比，0.351 [95% CI，0.177 至 0.67]）。此外，使用支气管阻滞剂与降低严重低氧血症的风险相关（优势比，0.290 [95% CI，0.125 至 0.62]）。结论 使用支气管阻滞剂与接受单肺通气的幼儿低氧血症风险降低相关。编辑观点 分别。306 人中有 153 人发生高碳酸血症（50%）。多变量分析中与低氧血症风险较低相关的因素包括左侧手术（优势比，0.45 [95% CI，0.251 至 0.78]）和支气管阻滞剂的使用（优势比，0.351 [95% CI，0.177 至 0.67]）。此外，使用支气管阻滞剂与降低严重低氧血症的风险相关（优势比，0.290 [95% CI，0.125 至 0.62]）。结论 使用支气管阻滞剂与接受单肺通气的幼儿低氧血症风险降低相关。编辑观点 分别。306 人中有 153 人发生高碳酸血症（50%）。多变量分析中与低氧血症风险较低相关的因素包括左侧手术（优势比，0.45 [95% CI，0.251 至 0.78]）和支气管阻滞剂的使用（优势比，0.351 [95% CI，0.177 至 0.67]）。此外，使用支气管阻滞剂与降低严重低氧血症的风险相关（优势比，0.290 [95% CI，0.125 至 0.62]）。结论 使用支气管阻滞剂与接受单肺通气的幼儿低氧血症风险降低相关。编辑观点 使用支气管阻滞剂与降低严重低氧血症的风险相关（比值比，0.290 [95% CI，0.125 至 0.62]）。结论 使用支气管阻滞剂与接受单肺通气的幼儿低氧血症风险降低相关。编辑观点 使用支气管阻滞剂与降低严重低氧血症的风险相关（比值比，0.290 [95% CI，0.125 至 0.62]）。结论 使用支气管阻滞剂与接受单肺通气的幼儿低氧血症风险降低相关。编辑观点