Questions · One-Lung Ventilation

22 questions, 2 approved. Approve them one at a time — a quiz shows nothing you have not.

Recall — derived from a kept point

Describe precisely what the individualised open-lung strategy consisted of in iPROVE-OLV, and why the comparator matters when interpreting the result. Answer: It was a bundle: an alveolar recruitment manoeuvre to 40 cm H2O end-inspiratory pressure, then individualised PEEP titrated to best respiratory system compliance, plus individualised postoperative respiratory support with high-flow oxygen therapy. The comparator received a fixed intraoperative PEEP of 4 cm H2O and conventional postoperative oxygen. Two cautions follow: the trial tests titrated PEEP against fixed low PEEP rather than protective against injurious ventilation, and because the intervention also changed postoperative oxygen therapy, the benefit cannot be attributed to intraoperative PEEP alone. It is evidence for the whole bundled strategy. Read both the control arm and the full intervention before deciding what a positive trial proved. A bundle that changes two things cannot tell you which one worked. Source claim: In iPROVE-OLV, treatment with iOLA included an alveolar recruitment manoeuvre to 40 cm H2O of end-inspiratory pressure followed by individualised PEEP titrated to best respiratory system compliance and individualised postoperative high-flow oxygen therapy, while the comparator received 4 cm H2O of PEEP and conventional postoperative oxygen therapy. iPROVE-OLV, Lancet Respir Med 2024 recall · CA-2 · phrased by llm

The iPROVE-OLV primary outcome was a composite. What components made it up, and what caution does a composite endpoint impose on how you quote the result? Answer: The composite of severe postoperative pulmonary complications within 7 days included atelectasis requiring bronchoscopy, severe respiratory failure, contralateral pneumothorax, early extubation failure requiring CPAP, non-invasive or invasive ventilation or reintubation, acute respiratory distress syndrome, pulmonary infection, bronchopleural fistula and pleural empyema. A composite pools events of very different severity, so a difference can be driven by the least severe component. The honest statement is that the strategy reduced this composite, not that it prevented ARDS or reintubation specifically. Name the composite's components before quoting its effect size. Recruitment-manoeuvre-related adverse events were reported in five patients, which also belongs in the conversation. Source claim: The iPROVE-OLV primary outcome was a composite of severe postoperative pulmonary complications within 7 days including atelectasis requiring bronchoscopy, severe respiratory failure, contralateral pneumothorax, early extubation failure (rescue with continuous positive airway pressure, non-invasive ventilation, invasive mechanical ventilation, or reintubation), acute respiratory distress syndrome, pulmonary infection, bronchopleural fistula and pleural empyema, with recruitment manoeuvre-related adverse events reported in five patients. iPROVE-OLV, Lancet Respir Med 2024 recall · CA-3 · phrased by llm

In thoracic surgery, general anesthesia with controlled ventilation is used, and one-lung ventilation was performed in ___% of cases. Answer: 64 In thoracic surgery, general anesthesia with controlled ventilation is used, and one-lung ventilation was performed in 64% of cases. Anesthetic management and morbidity in thoracic surgery: Results of the first series in Togo · PMID 38372517 recall · CA-2 · phrased by derived

This randomised trial found PEEP ___ cm H2O with periodic recruitment during one-lung ventilation did not reduce postoperative pulmonary complications and increased intraoperative hypotension compared with PEEP 5 cm H2O without routine recruitment. Answer: 10 This randomised trial found PEEP 10 cm H2O with periodic recruitment during one-lung ventilation did not reduce postoperative pulmonary complications and increased intraoperative hypotension compared with PEEP 5 cm H2O without routine recruitment. Effects of intraoperative higher versus lower positive end-expiratory pressure during one-lung ventilation for thoracic surgery on postoperative pulmonary complications (PROTHOR): a multicentre, international, randomised, controlled, phase 3 trial · PMID 41240959 recall · CA-2 · phrased by derived

This randomised trial found intraoperative intravenous or paravertebral lidocaine reduced pulmonary complications to ___% versus 45.1% with remifentanil after lung resection, with lower cytokine levels after one-lung ventilation. Answer: 22.3 This randomised trial found intraoperative intravenous or paravertebral lidocaine reduced pulmonary complications to 22.3% versus 45.1% with remifentanil after lung resection, with lower cytokine levels after one-lung ventilation. Effect of intraoperative paravertebral or intravenous lidocaine infusion on postoperative complications and inflammation after lung resection surgery: a randomised controlled trial · PMID 40897588 recall · CA-2 · phrased by derived

This randomized controlled trial found that flow-controlled ventilation required a respiratory minute volume of ___ L/min versus 4.5 L/min to achieve comparable mild hypercapnia during one-lung ventilation in patients undergoing elective thoracic surgery. Answer: 3.0 This randomized controlled trial found that flow-controlled ventilation required a respiratory minute volume of 3.0 L/min versus 4.5 L/min to achieve comparable mild hypercapnia during one-lung ventilation in patients undergoing elective thoracic surgery. Flow-controlled versus pressure-controlled ventilation in thoracic surgery with one-lung ventilation - A randomized controlled trial · PMID 40020438 recall · CA-2 · phrased by derived

This randomized controlled trial found no significant difference in PaO2 at ___ minutes of one-lung ventilation between remimazolam and sevoflurane in adults undergoing thoracoscopic surgery. Answer: 30 This randomized controlled trial found no significant difference in PaO2 at 30 minutes of one-lung ventilation between remimazolam and sevoflurane in adults undergoing thoracoscopic surgery. Comparison of remimazolam and sevoflurane on arterial oxygenation during one-lung ventilation in thoracoscopic surgery: a randomized controlled trial · PMID 41101786 recall · CA-2 · phrased by derived

This randomized trial found that lung-ultrasound-guided alveolar recruitment before one-lung ventilation reduced intraoperative hypoxaemia, defined as SpO2 less than ___ percent, to 1.2 percent versus 14.3 percent with conventional recruitment in patients aged 20 to 80 years undergoing lung resection. Answer: 95 This randomized trial found that lung-ultrasound-guided alveolar recruitment before one-lung ventilation reduced intraoperative hypoxaemia, defined as SpO2 less than 95 percent, to 1.2 percent versus 14.3 percent with conventional recruitment in patients aged 20 to 80 years undergoing lung resection. Effectiveness of ultrasound-guided alveolar recruitment in thoracic surgery with one-lung ventilation: a randomized-controlled trial · PMID 40581064 recall · CA-2 · phrased by derived

This randomised trial found higher PEEP of ___ cm H2O with periodic lung recruitment manoeuvres did not reduce pulmonary complications yet increased intraoperative hypotension versus lower PEEP of 5 cm H2O without routine recruitment. Answer: 10 This randomised trial found higher PEEP of 10 cm H2O with periodic lung recruitment manoeuvres did not reduce pulmonary complications yet increased intraoperative hypotension versus lower PEEP of 5 cm H2O without routine recruitment. Effects of intraoperative higher versus lower positive end-expiratory pressure during one-lung ventilation for thoracic surgery on postoperative pulmonary complications (PROTHOR): a multicentre, international, randomised, controlled, phase 3 trial · PMID 41240959 recall · CA-2 · phrased by derived

This randomised trial found intraoperative intravenous or paravertebral lidocaine reduced pulmonary complications to ___% versus 45.1% with remifentanil in lung resection patients undergoing one-lung ventilation. Answer: 22.3 This randomised trial found intraoperative intravenous or paravertebral lidocaine reduced pulmonary complications to 22.3% versus 45.1% with remifentanil in lung resection patients undergoing one-lung ventilation. Effect of intraoperative paravertebral or intravenous lidocaine infusion on postoperative complications and inflammation after lung resection surgery: a randomised controlled trial · PMID 40897588 recall · CA-2 · phrased by derived

This randomized trial found that during one-lung ventilation in elective thoracic surgery, flow-controlled ventilation needed a minute volume of only ___ L/min versus 4.5 L/min to maintain comparable mild hypercapnia. Answer: 3.0 This randomized trial found that during one-lung ventilation in elective thoracic surgery, flow-controlled ventilation needed a minute volume of only 3.0 L/min versus 4.5 L/min to maintain comparable mild hypercapnia. Flow-controlled versus pressure-controlled ventilation in thoracic surgery with one-lung ventilation - A randomized controlled trial · PMID 40020438 recall · CA-2 · phrased by derived

This randomized trial found that preemptive lung-ultrasound-guided alveolar recruitment before one-lung ventilation reduced intraoperative hypoxaemia, defined as SpO2 below ___%, to 1.2% versus 14.3% with conventional recruitment in patients aged 20-80 undergoing lung resection. Answer: 95 This randomized trial found that preemptive lung-ultrasound-guided alveolar recruitment before one-lung ventilation reduced intraoperative hypoxaemia, defined as SpO2 below 95%, to 1.2% versus 14.3% with conventional recruitment in patients aged 20-80 undergoing lung resection. Effectiveness of ultrasound-guided alveolar recruitment in thoracic surgery with one-lung ventilation: a randomized-controlled trial · PMID 40581064 recall · CA-2 · phrased by derived

The point with one number taken out. No model wrote any of this: the stem is the sentence you reviewed, minus a digit, and the paper it came from is named beneath it.

Open prompts

How do you definitively confirm correct placement of a double-lumen endotracheal tube? open · CA-2 · phrased by llm approved

What are the limitations of auscultation for verifying double-lumen tube position? open · CA-2 · phrased by llm

Why is bronchoscopic confirmation preferred over relying solely on clinical signs? open · CA-2 · phrased by llm

What specific findings on bronchoscopy indicate proper positioning of each lumen? open · CA-2 · phrased by llm