Hypoxemia in Young Children

Undergoing One-lung Ventilation:

A Retrospective Cohort Study

Wes Templeton MD FASA

Associate Professor of Anesthesiology

Wake Forest University School of Medicine

9 Day Old with a Cystic Hemartoma

Video of 9 day old

A Few Questions About

One-Lung Ventilation in Children

What is the

risk of

hypoxemia?

What is the

risk of

hypercarbia?

Does it matter

how we

execute OLV?

Does the side

of surgery

matter?

Could MPOG offer a novel

approach to begin to answering

questions like these for such a rare

case?

Design: Retrospective Observational

• Most series 15-50 patients

Initially query generated around 350-500 cases

15 institutions – First Multicenter Study on Pediatric OLV

• 2 mos – 3 years Inclusive

• Non cardiac procedures

• Required Documentation of OLV

• CPT codes - 32601, 32661, 32662, 32663, 32652, 32650, 32666, 32667, and 32100

Inclusion Criteria

Outcomes-Determined by Committee

• SpO2<90% for ≥ 3 minutes

Hypoxemia

• SpO2<90% for ≥ 5 minutes

Severe Hypoxemia

• ETCO2 > 60mmHg ≥ 5 minutes

• PaCO2 > 60mmHg

Hypercarbia

Execution Challenges

Number of cases

was still small

Determining OLV

start and stop

times

Not all covariates

on all patients

could be extracted

electronically

CPT codes not

specific enough to

build appropriate

filter

Solution to many of these issues

was manual review…

Individual Solutions

• Type and Number of cases – Posting had to be reviewed

• OLV Start and Stop Time – Ventilator data had to be manually

reviewed, couldn’t develop adequate logic…always forced to exclude

too many

• Tidal Volume

• FiO2

• ETCO2

OLV Start and OLV Stop

Time

A Few Results

(n=306 Patients)

Endobronchial intubation was

preferred almost 2-1

Risk of hypoxemia 26%

Risk of severe hypoxemia 18%

Risk of hypercarbia 50%

Risk Factors for

Hypoxemia

Endobronchial

Intubation vs

Blocker

Final

Thoughts

A new direction for MPOG

MPOG may have the power in many cases to

provide insights to rare cases and rare events…MH,

Anterior Mediastinal Masses, Difficult Airway

Validation? – approaches in the future especially for

large data sets where things have been extracted

electronically.

Prediction vs Inference?