What does this research mean for the field?

Both intermittent and continuous hypoxic preconditioning prior to pleural incision significantly improve arterial oxygenation during one-lung ventilation in patients undergoing thoracoscopic lung resection, though they do not significantly reduce postoperative pulmonary complications. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To investigate the effects of different hypoxic preconditioning strategies on arterial oxygenation and postoperative complications during one-lung ventilation.

April 25, 2026Open Access

Effects of various hypoxic preconditioning strategies on arterial oxygenation in patients undergoing one-lung ventilation during thoracoscopic surgery: a randomized clinical trial

Key Points

To investigate the effects of different hypoxic preconditioning strategies on arterial oxygenation and postoperative complications during one-lung ventilation.
Randomized controlled trial conducted with patients undergoing elective thoracoscopic right lung resection.
Participants were assigned to I-HPC, C-HPC, and control groups with arterial blood gas analyses at five time points during surgery.
Primary outcome measured was arterial oxygen partial pressure (PaO2) throughout the one-lung ventilation period.
The I-HPC group had significantly higher PaO2 at T3 (214.27 mmHg vs. 167.80 mmHg, P=0.015) and T4 (221.80 mmHg vs. 177.03 mmHg, P=0.023) compared to control.
The C-HPC group also showed higher PaO2 at T3 (217.35 mmHg vs. 167.80 mmHg, P=0.009) and T4 (220.81 mmHg vs. 177.03 mmHg, P=0.023) relative to control.
No significant differences in oxygen saturation, blood gas values, or postoperative complications were found among the groups (all P>0.05).

Abstract

One-lung ventilation (OLV) during thoracoscopic right lung resection can lead to challenges in maintaining arterial oxygenation and postoperative pulmonary complications. Hypoxic preconditioning (HPC) may improve outcomes in this setting. This study aimed to investigate the effects of different HPC strategies on arterial oxygenation during OLV and the incidence of postoperative pulmonary complications. This randomized controlled trial enrolled patients undergoing elective thoracoscopic right lung resection at the First Affiliated Hospital of Dalian Medical University from March 2022 to August 2022. Participants were randomly assigned to three groups in a 1:1:1 ratio: the I-HPC group receiving intermittent HPC, the C-HPC group receiving continuous HPC, and the RV group receiving regular two-lung ventilation (control group). Arterial blood gas analysis was conducted at five time points: at baseline prior to oxygen inhalation (T0), before the opening of the pleura (T1), and at 5 min (T2), 15 min (T3), and 30 min (T4) after the initiation of OLV. The primary outcome was the arterial oxygen partial pressure (PaO2) throughout the OLV period. Baseline arterial PaO₂ at T0 did not differ significantly among the three groups. The I-HPC group showed significantly higher PaO2 (mmHg) at T3 (214.27 ± 74.38 vs. 167.80 ± 65.68, P = 0.015) and T4 (221.80 ± 74.67 vs. 177.03 ± 70.94, P = 0.023) compared to the control group. The C-HPC group also had significantly higher PaO2 at T3 (217.35 ± 76.10 vs. 167.80 ± 65.68, P = 0.009) and T4 (220.81 ± 78.58 vs. 177.03 ± 70.94, P = 0.023) relative to the control group. No significant differences were found among the groups regarding intraoperative oxygen saturation, arterial blood gas values, respiratory and circulatory indicators, vasoactive drug usage, or postoperative pulmonary complications (all P > 0.05). Hypoxic preconditioning of the nondependent lung prior to pleural incision may enhance arterial oxygenation during OLV, suggesting that HPC could serve as a supportive measure for patients undergoing elective thoracoscopic lung resection. This study was registered on March 27th, 2022, in the Chinese Clinical Trial Registry (ChiCTR2200058026), prior to enrollment of the first participant, and no protocol changes were made after trial initiation.

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Cite This Study

Wu et al. (Thu,) studied this question.

synapsesocial.com/papers/69ec5a6b88ba6daa22dabe5f https://doi.org/https://doi.org/10.1186/s12890-026-04314-y

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