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. 2025 Sep 22;15(9):445.
doi: 10.3390/jpm15090445.

High Cerebral Oxygen Saturation Levels During One-Lung Ventilation Predict Better Cognitive and Clinical Outcomes After Thoracic Surgery: A Retrospective Observational Study

Ignacio Garutti  1   2   3 , Francisco de la Gala  1   3 , Javier Hortal  1   2   3 , Almudena Reyes  1   3 , Elena de la Fuente  1   3 , David Martinez-Gascueña  1   3 , Carlos Alberto Calvo  1   3 , Santiago Hernández  1   3 , Estrela Caamaño  1   3 , Carlos Simón  3   4   5 , Elena Vara  3   6 , Patricia Piñeiro  1   3
Affiliations

High Cerebral Oxygen Saturation Levels During One-Lung Ventilation Predict Better Cognitive and Clinical Outcomes After Thoracic Surgery: A Retrospective Observational Study

Ignacio Garutti et al. J Pers Med. .

Abstract

Background: Cerebral desaturation during one-lung ventilation (OLV) in thoracic surgery has been associated with postoperative cognitive dysfunction (POCD). While the adverse effects of low intraoperative regional cerebral oxygen saturation (rScO2) are well documented, the potential clinical value of maintaining supranormal rScO2 levels has not been thoroughly studied. Methods: We conducted a retrospective observational study based on a previously collected cohort from a tertiary university hospital. Adult patients undergoing elective thoracic surgery between January 2019 and December 2022 were included, provided they received lidocaine either intravenously or via a paravertebral block as part of a standardized anesthetic protocol. Patients were divided into the following two groups based on their mean INVOS values 30 min into OLV: those with rScO2 ≥75% (H-INVOS group) and <75% (L-INVOS group). Intraoperative physiological variables, inflammatory biomarkers, cognitive function via the Mini-Mental State Examination, and postoperative outcomes were analyzed. Results: The H-INVOS group exhibited significantly higher preoperative lung function, higher PaO2 and PaCO2 values during OLV, and higher hemoglobin concentrations across all timepoints. They also demonstrated better preservation of cognitive function, lower IL-18 expression at 24 h postoperatively, and shorter hospital stays. There were no statistically significant differences in intraoperative hemodynamics or ventilatory mechanics.

Keywords: neuroinflammation; one-lung ventilation; permissive hypercapnia; postoperative cognitive dysfunction (POCD); regional cerebral oxygen saturation (rScO2); thoracic surgery.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
INVOS values during surgery (high vs. low INVOS groups). OLV + 30: After 30 min of one-lung ventilation; TLV: Two-lung ventilation; p < 0.001 High INVOS vs. Low INVOS groups.
Figure 2
Figure 2
IL-6 levels over time by INVOS group. Footnote: OLV + 30: After 30 min of one-lung ventilation; TLV: Two-lung ventilation; PO: Postoperative. p < 0.05: High INVOS vs. Low INVOS groups.
Figure 3
Figure 3
Kaplan Meier curves. INVOS ≥ 75 vs. <75 during one-lung ventilation.
See this image and copyright information in PMC

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