Cardiothoracic & vascular anesthesia
Preoperative Multivariable Model for Risk Stratification of Hypoxemia During One-Lung Ventilation
Authors' conclusion
The risk of hypoxemia during OLV can be stratified preoperatively using accessible clinical variables. Our risk model is well calibrated but showed moderate discrimination for predicting intraoperative hypoxemia.
Study context
- Population
- Patients undergoing elective lung resection with one-lung ventilation (OLV) (lateral decubitus, double lumen tube), tertiary academic centre, US, 2017–2022
- Participants
- 3,228 patients
- Outcome
- Risk stratification model for intraoperative hypoxemia during OLV (SpO2 <90% for at least 5 minutes) based on preoperative clinical variables
Methodological detailssingle-centre, risk prediction model development, internal validation with bootstrapping
- Single-centre
- Risk prediction model development
- Internal validation with bootstrapping
Main finding
As reported in the abstract
Hypoxemia during OLV and risk model performance
- Incidence of hypoxemia during OLV
- 8.9% (95% CI 8.0-10.0)
- Risk factors (points): preoperative SpO2 <92% (15), hemoglobin <10 g/dL (6), age >60 years (4), male sex (4), BMI >30 kg/m 2 (8), DM (4), congestive HF (7), hypertension (3), right-sided surgery (3)
- 9
- AUC after bootstrap correction
- 0.708 (95% CI 0.676-0.74)
- Optimal score (highest Youden index)
- 13
- Risk of hypoxemia, first quartile of scores (0-13 points)
- 4.7%
- Risk of hypoxemia, third quartile (27-39 points)
- 32%
- Risk of hypoxemia, fourth quartile (>39 points)
- 83.3%
- Scores ≥20: PPV
- 80%
Observational data: associations, not effects.
Original publication
Preoperative Multivariable Model for Risk Stratification of Hypoxemia During One-Lung Ventilation. Anesth Analg. Published 1 May 2025. doi:10.
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