One-lung ventilation (OLV) in infants is technically demanding and is typically reported from high-volume centers. We describe here perioperative management using OLV in a 6-month-old, 3.5-kg infant undergoing resection of a large emphysematous lung lesion at a low-volume center. Due to limited institutional experiences and anticipated airway challenges, the anesthetic strategy prioritized structured decision-making, predefined withdrawal criteria, and anesthesiologist-led multidisciplinary briefings and simulations. The key elements included planned apneic oxygenation using nasal high-flow oxygen and preparation of alternative confirmation methods. During surgery, bronchial blocker dislodgement required deviation from the initial plan; however, shared situational awareness and open communication enabled flexible adaptation and maintenance of stable ventilation. This case highlights that in rare, high-risk pediatric airway management, non-technical skills-including planning, communication, and team coordination-may play a critical role in ensuring patient safety, particularly in low-volume settings.

Supraglottic jet ventilation (SJV) is used during flexible bronchoscopy to improve oxygenation, but its impact on overall lung ventilation is unclear. Thoracic electrical impedance tomography (EIT) offers real-time monitoring of respiratory function. This prospective pilot study enrolled patients undergoing flexible bronchoscopy. End-expiratory lung impedance (EELI) changes from baseline (ΔEELI) were measured at baseline (T0), oxygenation with Wei nasal jet (WNJ) (T1), SJV (T2), during bronchoscopy (T3), and post-bronchoscopy (T4). The primary outcome was ΔEELI at T2 vs. T3. Secondary outcomes included ΔEELI at other time points, ventilation distribution (ventral vs. total lung, ROIventral), hemodynamics, oxygen saturation (SpO2) at each point, and adverse events. Among 27 patients, 5 experienced transient desaturation (no laryngeal mask ventilation needed). ΔEELI and SpO2 significantly decreased from T2-T3 (ΔEELI: -2.65, 95% CI -4.27 to -1.02, p < 0.001; SpO2: -2.5%, 95% CI -4.7 to -0.3%, p < 0.001). Conversely, ΔEELI and SpO2 significantly increased from T1-T2 (ΔEELI: 1.84, 95% CI 1.02-2.66, p < 0.001; SpO2: 3.3%, 95% CI 1.3-5.2%, p < 0.001), with ROIventral rising from 43.7 to 60.4% (16.6% increase, 95% CI 4.4-28.9%, p < 0.001). While SJV did not prevent the negative effects of bronchoscopy on lung ventilation and oxygenation, it maintained adequate SpO2. Pre-bronchoscopy SJV improved these measures, but shifted ventilation towards ventral lung regions compared to WNJoxygenation. Chinese Clinical Trial Registry (URL: Chictr.org.cn), Identifier: ChiCTR2100050285. Date of registration: Aug 25th, 2021.

Despite advancements in surgical patient care, postoperative pulmonary complications (PPCs) following emergency abdominal surgery remain common and are linked to increased morbidity, mortality, and healthcare costs. This study aims to identify the incidence and risk factors of PPCs following major emergency abdominal surgery. This is a single-center observational study including patients undergoing major emergency abdominal surgery between January 1, 2021, and December 31, 2023, collecting pre-, intra-, and postoperative variables. The primary outcome was the occurrence of PPCs, and the secondary outcomes were risk factors for PPCs and 30-day mortality rates following PPCs. Multivariable logistic regression was used to identify perioperative risk factors associated with PPCs. The same analysis was used on a subgroup of patients with 'severe' PPCs. Of 1080 patients included in the study, 431 (39.9%) had at least one PPC, and 150 (13.9%) had at least one 'severe' PPC. Multivariable logistic regression identified several risk factors for developing PPCs: an increased ARISCAT score, a history of pulmonary disease, hypertension, a history of cerebral disease, increased Clinical Frailty Scale, preoperative admission to the intensive care unit, a CDC grade IV contaminated wound, intraoperative findings of perforated stomach or duodenal ulcer, need for subsequent reoperations, and protracted postoperative ileus. Patients with PPCs had a 30-day mortality rate of 21.0%, while those with 'severe' PPCs had a 30-day mortality rate of 46.3%. Several independent risk factors, beyond those already established, were associated with an increased risk of PPCs.