Safe pediatric one-lung ventilation in a resource-limited setting: an age- and weight-guided approach
Journal
Egyptian Pediatric Association Gazette
Date Issued
2025-12-10
Author(s)
Sulejmani, Haris
Golubic, Sanja
DOI
10.1186/s43054-025-00469-1
Abstract
Background
One-lung ventilation (OLV) in children is technically demanding due to small airway calibers, variable bronchial anatomy, and limited pediatric-specific devices. Challenges are greater in resource-limited settings where double-lumen tubes (DLTs) and fiberoptic bronchoscopes are not consistently available.
Methods
We retrospectively reviewed five consecutive pediatric patients (ages 4–13 years) who underwent thoracic surgery with OLV between 2022 and 2024. Case summaries highlighted device choice, confirmation method, and perioperative challenges. Variables included demographics, diagnosis, surgical side, isolation technique, OLV duration, ventilatory parameters, arterial blood gases, and defined outcomes (desaturation, hypercarbia, hemodynamic instability, device dislodgement, and postoperative complications).
Results
Lung isolation was achieved with DLTs in two older patients and bronchial blockers in three younger ones, guided by age and weight. OLV lasted 105–150 min. Two children developed transient desaturation (nadir SpO₂ 75%), one experienced hypercarbia (PaCO₂ >50 mmHg), and two had hemodynamic instability. No tube dislodgement occurred. Median ICU stay was 17 h (IQR 8–19), and hospital stay 21 days (IQR 15–21). All patients were discharged in stable condition.
Conclusion
An age- and weight-based algorithm bronchial blockers for children < 8 years or < 30 kg, DLTs for older/heavier patients enabled safe OLV and preserved oxygenation, even without routine fiberoptic bronchoscopy. Vigilant ETCO₂ monitoring, careful device fixation, and close intraoperative assessment compensated for equipment limitations. This pragmatic workflow demonstrates feasibility in resource-constrained environments, provides practical guidance for clinicians, and is hypothesis-generating for future multicenter studies.
One-lung ventilation (OLV) in children is technically demanding due to small airway calibers, variable bronchial anatomy, and limited pediatric-specific devices. Challenges are greater in resource-limited settings where double-lumen tubes (DLTs) and fiberoptic bronchoscopes are not consistently available.
Methods
We retrospectively reviewed five consecutive pediatric patients (ages 4–13 years) who underwent thoracic surgery with OLV between 2022 and 2024. Case summaries highlighted device choice, confirmation method, and perioperative challenges. Variables included demographics, diagnosis, surgical side, isolation technique, OLV duration, ventilatory parameters, arterial blood gases, and defined outcomes (desaturation, hypercarbia, hemodynamic instability, device dislodgement, and postoperative complications).
Results
Lung isolation was achieved with DLTs in two older patients and bronchial blockers in three younger ones, guided by age and weight. OLV lasted 105–150 min. Two children developed transient desaturation (nadir SpO₂ 75%), one experienced hypercarbia (PaCO₂ >50 mmHg), and two had hemodynamic instability. No tube dislodgement occurred. Median ICU stay was 17 h (IQR 8–19), and hospital stay 21 days (IQR 15–21). All patients were discharged in stable condition.
Conclusion
An age- and weight-based algorithm bronchial blockers for children < 8 years or < 30 kg, DLTs for older/heavier patients enabled safe OLV and preserved oxygenation, even without routine fiberoptic bronchoscopy. Vigilant ETCO₂ monitoring, careful device fixation, and close intraoperative assessment compensated for equipment limitations. This pragmatic workflow demonstrates feasibility in resource-constrained environments, provides practical guidance for clinicians, and is hypothesis-generating for future multicenter studies.