One-lung ventilation (OLV) is required for video-assisted thoracoscopic surgery (VATS) lung resection, but it exposes the dependent lung to atelectasis, high driving pressures, and oxidative stress, and is associated with postoperative pulmonary complications. Volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) are the conventional modes used during OLV. Flow-controlled ventilation (FCV) is a newer mode that delivers a constant gas flow during both inspiration and expiration through a narrow-bore endotracheal tube, and has been proposed to improve gas distribution and reduce mechanical stress on the lung.
This prospective observational study evaluates oxygenation and respiratory mechanics in adult patients undergoing elective VATS lung resection under OLV. The ventilation mode used for each patient is determined by the attending anaesthesiologist as part of routine clinical care, independently of the study; investigators do not participate in any aspect of patient management and collect data through observation only. Patients are grouped according to the mode used in clinical practice (FCV, VCV, or PCV).
The primary outcome is arterial oxygenation (PaO₂) at 30 minutes of OLV. Secondary outcomes include dynamic lung compliance, driving pressure, mechanical power, and haemodynamic parameters recorded at predefined intervals. A total of 120 patients (ASA I-III, GOLD stage 1-2) are planned for enrolment.
-Age 18 years and older
American Society of Anesthesiologists (ASA) physical status I, II, or III
Scheduled for elective lung resection by video-assisted thoracoscopic surgery (VATS)
Planned one-lung ventilation
ASA physical status IV or older
Emergency surgery
Previous neoadjuvant chemotheraphy or radiotherapy
GOLD 2026 group 3 or group 4
Patients aged 18 years and older, ASA physical status I-III, scheduled for elective lung resection by video-assisted thoracoscopic surgery (VATS) with planned one-lung ventilation under total intravenous anesthesia at a single tertiary center. Patients are assigned to one of three groups according to the ventilation mode selected by the attending anesthesiologist (FCV, VCV, or PCV); no randomization is performed.
Cohort
Prospective
Not listed
Partial pressure of oxygen (PaO₂) during one-lung ventilation
PaO₂ in mmHg obtained from arterial blood gas analysis of a radial artery sample, measured at 30 minutes after the initiation of one-lung ventilation, with FiO₂ recorded simultaneously
PaO₂/FiO₂ ratio
Ratio of the partial pressure of arterial oxygen to the inspired oxygen fraction, calculated from arterial blood gas analysis.
Partial pressure of arterial carbon dioxide (PaCO₂)
PaCO₂ in mmHg obtained from arterial blood gas analysis.
Dynamic Compliance
Dynamic compliance obtained from ventilator readings
Pleteau Pressure
Pleteau pressure obtained from ventilator readings
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