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Clinical practice of one-lung ventilation in mainland China: a nationwide questionnaire survey

BMC Anesthesiology volume 25, Article number: 7 (2025) Cite this article

Abstract

Background

Limited information is available regarding the application of lung-protective ventilation strategies during one-lung ventilation (OLV) across mainland China. A nationwide questionnaire survey was conducted to investigate this issue in current clinical practice.

Methods

The survey covered various aspects, including respondent demographics, the establishment and maintenance of OLV, intraoperative monitoring standards, and complications associated with OLV.

Results

Five hundred forty-three valid responses were collected from all provinces in mainland China. Volume control ventilation mode, 4 to 6 mL per kilogram of predictive body weight, pure oxygen inspiration, and a low-level positive end-expiratory pressure ≤ 5 cm H2O were the most popular ventilation parameters. The most common thresholds of intraoperative respiration monitoring were peripheral oxygen saturation (SpO2) of 90–94%, end-tidal CO2 of 45 to 55 mm Hg, and an airway pressure of 30 to 34 cm H2O. Recruitment maneuvers were traditionally performed by 94% of the respondents. Intraoperative hypoxemia and laryngeal injury were experienced by 75% and 51% of the respondents, respectively. The proportions of anesthesiologists who frequently experienced hypoxemia during OLV were 19%, 24%, and 7% for lung, cardiovascular, and esophageal surgeries, respectively. Up to 32% of respondents were reluctant to perform lung-protective ventilation strategies during OLV. Multiple regression analysis revealed that the volume-control ventilation mode and an SpO2 intervention threshold of < 85% were independent risk factors for hypoxemia during OLV in lung and cardiovascular surgeries. In esophageal surgery, working in a tier 2 hospital and using traditional ventilation strategies were independent risk factors for hypoxemia during OLV. Subgroup analysis revealed no significant difference in intraoperative hypoxemia during OLV between respondents who performed lung-protective ventilation strategies and those who did not.

Conclusions

Lung-protective ventilation strategies during OLV have been widely accepted in mainland China and are strongly recommended for esophageal surgery, particularly in tier 2 hospitals. Implementing volume control ventilation mode and early management of oxygen desaturation might prevent hypoxemia during OLV.

Peer Review reports

Background

One-lung ventilation (OLV), typically achieved by placing a double-lumen endotracheal tube (DLET) or bronchial blockers, plays a critical role in cardiothoracic surgery by providing optimal surgical exposure and protection of the nonoperated lung. Currently, lung protective ventilation strategies (LPVSs), characterized by low tidal volume, permissible hypercapnia, individualized positive end-expiratory pressure (PEEP), recruitment maneuvers, and low inspiratory oxygen concentrations, have become increasingly popular worldwide [1]. Studies have also reported that the perioperative application of LPVS can ameliorate ventilation-induced lung injury, reduce postoperative pulmonary complications (PPCs), and improve patient outcomes, especially in those at high risk for PPCs [2, 3]. However, no consensus or guidelines for LPVSs during OLV have been achieved. Ongoing debates persist regarding the benefit of the ventilation strategy and how to set the proper perioperative ventilation parameters [4].

Hypoxia is one of the most common complications during and after OLV, affecting 3.6–10.0% [5, 6] of patients undergoing OLV, and leads to cerebral dysfunction [7], myocardium ischemia [8], arrhythmia [9], and pulmonary hypertension [10]. In addition to inhibited hypoxic pulmonary vasoconstriction (HPV), hypoxia may be partially caused by airway problems, preexisting lung malfunction, and inappropriate ventilation strategies (high tidal volume, zero PEEP, etc.). Additional risk factors for intraoperative hypoxemia in cardiothoracic surgery include the side of surgery, surgical position, and the volume of the excised lung [6, 11].

This study aimed to explore the routine strategy for establishing and maintaining OLV in cardiothoracic surgery in China through a nationwide questionnaire survey and to identify the risk factors for intraoperative hypoxia during OLV in clinical practice using the lung isolation technique.

Methods

Study design

From October 2023 to December 2023, the WJS.cn survey platform (https://www.wjx.cn) was utilized to conduct this nationwide questionnaire survey about the practical experience in the LPVS of the OLV during cardiothoracic surgery. The survey included respondent demographics, the methods of OLV establishment, the intraoperative monitoring standards, and the complications associated with DLET intubation (see Additional file 1). All in-service anesthesiologists from mainland China were enrolled in this survey via the internet, which contained 30 questions propagated through WeChat (Tencent, Shenzhen, China) designed by the investigators. The answer sheets with (1) a repeat response from the same internet Protocol number, (2) less than 60 s of answer time, (3) incomplete answers, and (4) less than 1 year of anesthetic occupation experience were excluded from this survey.

Statistical methods

Data processing and analysis were performed using R version 4.3.0 (2023-04-21) and Zstats v 0.90 (www.medsta.cn/software). All statistical graphs were generated using Microsoft PowerPoint 2010 (Microsoft, USA) and GraphPad Prism 8.0.1 (GraphPad Software, USA). P < 0.05 was considered statistically significant. Respondent characteristics are presented as frequencies and percentages for categorical variables. The respondents were divided into two groups according to the incidence of intraoperative hypoxia: hypoxia occurred frequently, classified as high incidence, and never or occasionally occurred classified as low incidence), and univariate regression was performed. The multivariate logistic regression subsequently included the variables with a P value < 0.1. Finally, a subgroup analysis was performed using a forest plot to compare differences between the respondents who routinely received LVPS and those who received conventional ventilation in terms of the proportion of patients with high incidence rates of intraoperative hypoxia.

Results

General data presentation

A total of 600 questionnaires were distributed, 565 of which were successfully collected, including 543 valid responses (543/600, 90.5%) that covered all provincial administrative units in mainland China. Twenty-two responses were excluded from the study (see Figs. 1 and 2). More than two-thirds of the respondents held the title of chief physician, 86% of whom came from Tier 3 hospitals. The respondents’ titles, gender, age, hospital location, hospital tiers, and years of experience in anesthesiology are presented in Fig. 3.

Fig. 1
figure 1

Flow chart

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Fig. 2
figure 2

Regional distribution of the respondents in mainland China

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Fig. 3
figure 3

General information of the respondents. A Titles of the respondents; B Gender of the respondents; C Age of the respondents. D Tiers of hospitals. E Duration in the field of anesthesiology

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One-lung ventilation establishment

Most respondents routinely evaluated respiratory function before surgery (see Fig. 4). The DLET and visual laryngoscope were commonly used to establish OLV (see Fig. 5A and B). The decision-making process for the sizes of artificial airways was based on body shape, sex, airway inner diameter, and surgical site for most of the respondents (see Fig. 5C). Bronchoscopy, visual DLET, and other visualization equipment were utilized for endotracheal placement in three-fourths of the respondents (see Fig. 5D). More than half of the respondents used pure oxygen preinhalation and traditional methods for lung collapse (see Fig. 5E).

Fig. 4
figure 4

Proportions of respondents whose respiratory function was evaluated at different frequencies

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Fig. 5
figure 5

The establishment of one-lung ventilation. A Lung isolation techniques; B Intubation tools; C Decision-making criteria for the sizes of artificial airways; D Intubation location; E Pulmonary collapse maneuvers

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Mechanical ventilation parameters

Up to 32% of respondents were reluctant to perform LPVS during OLV, with many citing concerns that LPVS was a complicated and impractical technique during cardiothoracic surgery (see Fig. 6). More than half of the respondents chose pure oxygen inspiration during OLV because of concerns about hypoxemia. Volume-controlled ventilation (VCV) mode, recruitment maneuvers, 4 to 6 mL per kilogram predictive body weight, pure oxygen inspiration, and a low-level PEEP of ≤ 5 cm H2O were accepted by most respondents (see Fig. 7A, B, C, D and E). The most prevalent reason for performing pure oxygen inhalation during one-lung ventilation was concern about intraoperative hypoxemia (see Fig. 7F).

Fig. 6
figure 6

Reasons why the lung protective ventilation strategies were not performed during one-lung ventilation

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Fig. 7
figure 7

Mechanical ventilation parameters. A Ventilation mode; B Lung recruitment maneuvers; C Initial tidal volume; D Initial FiO2; E Preferred positive end-expiratory pressure; F Reasons for pure oxygen inhalation during one-lung ventilation

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Intraoperative ventilation monitoring

The most common thresholds for intraoperative monitoring values were a peripheral oxygen saturation (SpO2) of 90–94%, an end-tidal carbon dioxide (ETCO2) of 45–55 mm Hg, and an airway pressure of 30–34 cm H2O (see Fig. 8).

Fig. 8
figure 8

Monitoring of intraoperative ventilation. A Lower threshold of SpO2; B Upper threshold of ETCO2; C Upper threshold of airway pressure

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Perioperative complications

Hypoxemia was commonly observed during OLV surgery. The percentages of anesthesiologists who frequently experienced intraoperative hypoxemia were 19%, 24%, and 7% for lung, cardiovascular, and esophageal surgeries, respectively (see Fig. 9A). Hypoxemia and laryngeal injury were frequently experienced by 75% and 51% of the respondents, respectively (see Fig. 9B). Subgroup analysis revealed that no significant differences were observed between respondents who performed LPV during OLV and those who did not with respect to the high incidence of intraoperative hypoxemia (see Fig. 10).

Fig. 9
figure 9

Perioperative complications. A The proportions of respondents who experienced hypoxemia among different surgeries; B Complications frequently occurred after one-lung ventilation

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Fig. 10
figure 10

Subgroup analysis for the risk factors for hypoxemia during one-lung ventilation. A forest plot was constructed to compare differences between respondents who routinely received lung-protective ventilation strategies and those who received conventional ventilation strategies in terms of the incidence of intraoperative hypoxia

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Multiple regression analysis

The application of the VCV mode (OR: 0.54, 95% CI: 0.33–0.88, P = 0.014) and an SpO2 intervention threshold of < 85% (OR: 4.40, 95% CI: 1.12–17.36, P = 0.034) were identified as independent risk factors for hypoxemia during OLV in lung surgery patients (see Additional file 2). The same risk factors were found for cardiovascular surgery (OR: 0.57, 95% CI: 0.34–0.94, P = 0.027; OR: 5.29, 95% CI: 1.31–21.45, P = 0.020) (see Additional file 3). In esophageal surgery, hospital tier and the traditional ventilation strategy were independent risk factors for postoperative hypoxemia after OLV (OR: 3.04, 95% CI: 1.32–6.97, P = 0.009; OR: 3.04, 95% CI: 1.32–6.97, P = 0.009) (see Additional file 4).

Discussion

Preoperative evaluation

Preoperative evaluation of respiratory function is crucial for preventing PPCs during cardiothoracic surgery. Chest computerized tomography clearly identifies preexisting pulmonary lesions and tracheal abnormalities [12, 13]. The need for lung function examination for patients scheduled for lobectomy is unassailable. The predicted postoperative forced expiratory volume in 1 s is the most effective index for predicting respiratory complications after thoracic surgery, while maximal oxygen uptake is the best predictor of postoperative prognosis [14]. A peak oxygen uptake of < 17 mL/(kg·min) and an anaerobic threshold of < 10.5 mL/(kg·min) were considered to be related to increased complications and a lower 5-year survival rate following esophageal surgery [15]. Arterial blood gas analysis can serve as a supplementary assessment for patients unable to undergo lung function examinations before thoracic surgery. While preoperative hypoxemia is a risk factor for postoperative complications, hypercapnia is not [16].

Establishment of lung isolation

Lung isolation is the core technique in anesthetic management during cardiothoracic surgery, in which DLET and bronchial blockers are frequently utilized for establishing OLV [17]. No significant difference was found regarding the efficacy of intraoperative lung collapse between the two commonly used lung isolation techniques. However, DLET intubation seemed more time-saving in the bronchial location [18]. As a result, 94% of the respondents in the study reported using DLET. Successful lung isolation during surgery depends on precise endotracheal placement. It has been reported that chest auscultation contributes to 35% of malposition cases during bronchial intubation [19]. Therefore, fiberoptic bronchoscopy is considered the gold standard globally [20, 21]. However, some of the respondents (24%) relied on their clinical experiences, which may reflect a shortage of visual equipment in primary hospitals in mainland China.

Cardiothoracic surgery benefits from effective lung collapse, which consists of two stages. The lung rapidly deflates under the elastic force of the alveoli in the first stage, lasting less than one minute. As the small airway closes, the second stage begins, and the residual gas in the alveoli is slowly absorbed by the pulmonary capillary. Compared with the conventional manipulation of lung collapse, the open-clamp airway technique described by Rong Huang and colleagues was associated with more rapid and complete lung collapse and a lower incidence of hypoxemia during surgery [22]. A small-sample randomized controlled trial recently reported that preemptive OLV for lung collapse in thoracoscopic surgery was effective and safe [23]. However, conventional lung collapse manipulation was routinely performed by more than half of the respondents enrolled in this study, revealing that it was convenient and reliable for the majority of Chinese anesthesiologists under the stress of a heavy workload.

Lung protective ventilation strategy

The volume control ventilation mode, a tidal volume of 4 to 6 mL per predictive body weight (kg), pure oxygen inspiration, and a low-level PEEP of < 5 cm H2O were the most acceptable ventilation parameters for the respondents in this study. Logistic regression analysis indicated that the VCV mode was an independent risk factor for intraoperative hypoxemia in pulmonary and cardiac surgery patients in this study. Compared with the volume control ventilation mode and the pressure control volume guarantee mode, lower airway pressure and higher dynamic lung compliance were monitored in patients in the pressure control ventilation mode. However, no significant difference was observed in the incidence of PPCs, indicating a weak relationship between airway pressure, dynamic lung compliance, and short-term respiratory outcomes after surgery [24, 25]. Moreover, patients at high risk of PPCs might benefit from the VCV mode, which is associated with lower volume and driving pressure [26]. Coincidentally, the majority of respondents in this study routinely performed VCV during surgery. However, the authors could not confirm the reason why the VCV mode was prevalent in mainland China.

While low tidal volume ventilation is recommended for LPVSs, the incidence of PPCs does not decrease in patients without a proper level of PEEP during surgery [27]. Accordingly, most anesthesiologists in mainland China support this approach and utilize low tidal volume and low-level PEEP in their daily clinical practice. However, what we should note is that debates still exist regarding whether low tidal volume ventilation combined with proper PEEP can reduce the number of PPCs in OLV [28].

High concentrations of inhaled oxygen can cause oxygen toxicity, resorption atelectasis, and other oxidative stress injuries and are closely associated with high incidences of PPCs and 30-day mortality [29, 30]. Nevertheless, 100% FiO2 has been widely adopted in China. Not surprisingly, the main reason was the concern about intraoperative hypoxemia following OLV. The authors strongly recommend titrating the FiO2 from a low level and keeping the FiO2 as low as possible to maintain good oxygenation during OLV.

As previously mentioned, a proper PEEP setting plays an essential role in LPVS, preventing pulmonary atelectasis following long-term low tidal volume ventilation. However, no consensus has been reached concerning the standard PEEP level during OLV. A 5 cm H2O PEEP setting failed to alleviate pulmonary inflammation and reduce serum biomarkers related to lung injury in patients who underwent OLV during esophagectomy [31]. In contrast, another observational study reported reduced PPCs at 5 cm H2O PEEP compared with zero PEEP [30]. These findings demonstrated that patients experienced a lower incidence of pulmonary atelectasis and better lung compliance after driving pressure-guided ventilation with 8 cm H2O PEEP in on-pump cardiac surgery [32]. Moreover, a multicenter randomized control trial confirmed the critical role of driving pressure in the PEEP setting, indicating its positive effect on intraoperative oxygenation function [33]. In general, a modified driving pressure of < 16 cm H2O was independently correlated with a lower incidence of PPCs, whereas VT < 8 ml/kg and PEEP ≥ 5 cm H2O were not associated with similar outcomes [34]. Hence, individualized PEEP settings according to the driving pressure level may be rational during OLV to optimize lung compliance and improve outcomes [35, 36]. Unfortunately, only a few respondents in this study performed PEEP titration during OLV, and the burdensome clinical task in mainland China and time constraints for driving pressure setting might explain the unsatisfactory results.

Alveolar recruitment maneuvers can prevent pulmonary atelectasis and improve oxygenation during general anesthesia [37]. Nearly all respondents in this study performed manual recruitment maneuvers during OLV. Notably, however, alveolar recruitment maneuvers have been associated with barotrauma, arrhythmia, re-expansion pulmonary edema, and recurrent atelectasis [38].

Permissive hypercapnia represents a fundamental component of LPVSs and was adopted as part of the ventilation strategy by the majority of respondents in this study. First, hypercapnia may potentiate HPV, augmenting blood flow to the ventilated lung and improving ventilationperfusion (V/Q) matching. Second, mild hypercapnia may stimulate the sympathetic nervous system, leading to increased cardiac output. Specifically, 35% of the respondents permitted ETCO2 levels between 56 and 65 mmHg during OLV, whereas 46% adhered to a more conservative strategy, maintaining the intervention threshold within the range of 45–55 mmHg. A recent prospective, randomized controlled trial suggested that the intraoperative target arterial carbon dioxide tensions of 50 ± 5 mm Hg and 60 ± 5 mm Hg significantly improved pulmonary oxygenation during OLV compared with 40 ± 5 mmHg, without a higher incidence of PPCs or prolongation of hospital stay [39].

Moreover, up to 32% of respondents did not accept LPVS during OLV, and most regarded LPVS as a complicated and impractical ventilation strategy. Colquhoun, DA, and colleagues reported no obvious difference in outcomes as the application of LPVS increased [28], indicating that the individualization ventilation strategy was more rational for OLV during cardiothoracic surgery.

Airway pressure during one-lung ventilation

Barotrauma serves as a pivotal mechanism contributing to ventilator-induced lung injury [40]. Evidence from numerous studies suggests that lower driving pressures are linked to a decreased incidence of PPCs [30]. In contrast, elevated driving pressure contributes to lung injury during positive-pressure ventilation [41]. Hence, airway pressure should be maintained below 30 cm H2O, which is associated with a reduced risk of death in patients with acute lung injury [42]. In patients with compromised pulmonary function, it is recommended that peak airway pressures remain under 20 to 25 cm H2O [43]. Moreover, elevated airway pressure may reduce preload and increase afterload to the right ventricle, leading to hypoxemia and hemodynamic disturbance [44]. Notably, high airway pressure during OLV usually indicates malposition or obstruction of the DLET [45]. Unfortunately, the authors found that up to 65% of respondents did not check the airway unless the airway pressure rose to ≥ 30 cm H2O during OLV, indicating a prevalence of undervaluation of abnormal airway pressure during surgery. Given the serious adverse outcomes, high airway pressure should not be ignored and must be addressed immediately.

Hypoxemia during one-lung ventilation

Hypoxemia, characterized by a SpO2 of less than 90% or partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2) of less than 40 KPa (300 mm Hg) [46, 47], frequently occurs during OLV [6]. With advances in lung isolation techniques and anesthetics, intraoperative hypoxemia has decreased significantly [6, 48]. However, 74.6% of the respondents in this study reported episodes of transient hypoxemia during OLV, and 5.0–23.0% of them frequently experienced intraoperative hypoxemia, suggesting that hypoxemia during OLV is still common and warrants more attention in cardiothoracic surgery in China.

No consensus has been reached on the optimal intervention threshold for hypoxemia during OLV. Transient mild hypoxemia (SpO2 of 85–90%) may be acceptable, followed by elevated cardiac output and hemoglobin levels [49]. However, a dose-dependent relationship has been reported between intraoperative hypoxemia (SpO2 < 90% for more than 2 min) and postoperative delirium [50]. Given that elderly patients with multiple comorbidities may have impaired tolerance to hypoxemia, maintaining SpO2 ≥ 90% during OLV is generally recommended. In this study, a SpO2 of 90% or higher was accepted by 69% of interviewers, and 23% did not address hypoxemia until the SpO2 decreased from 85 to 89%. Moreover, a transient SpO2 of less than 85% was permitted in 8% of the respondents. Logistic regression analysis revealed that a threshold of SpO2 < 85% was an independent risk factor for intraoperative hypoxemia during pulmonary and cardiovascular surgeries, which may be explained by several factors: (1) As the relationship between PaO2 and arterial oxygen saturation is not linear, pulse oximetry cannot provide immediate warning of hypoxemia [51, 52]. (2) SpO2 values lower than 85% during surgery indicate several critical situations requiring urgent management, such as DLET malposition [45], airway obstruction with sputum, or severe V/Q rate mismatches due to increased nonventilated perfusion [6]. (3) Compared with other thoracic surgeries, cardiopulmonary dysfunction often occurs in lung and cardiovascular surgeries. Accordingly, frequent hypoxemia was reported in 19% of respondents during OLV in pulmonary surgery and by 24% in cardiovascular surgery in our study. In contrast, only 7% of respondents frequently reported hypoxemia during OLV in esophageal surgery, suggesting that OLV impaired oxygenation function in cardiopulmonary surgery.

Logistic regression analysis identified tier 2 hospitals and conventional ventilation strategies as independent risk factors for hypoxemia during OLV in esophageal surgery patients. The relatively high incidence of intraoperative hypoxemia in tier 2 hospitals may be attributable to staffing shortcomings, inadequate mechanical facilities, lower professional levels, and suboptimal anesthetic strategies. Michelet and colleagues demonstrated that the LPV strategy can mitigate the systemic proinflammatory response in patients undergoing esophagectomy, improve the PaO2/FiO2 ratio, and shorten the duration of postoperative mechanical ventilation [53]. Furthermore, the duration of OLV has been verified as a risk factor for PPCs in esophageal surgery, emphasizing the importance of minimizing OLV duration and using LPV strategies [54]. Based on these findings, LPV is strongly recommended to reduce the incidence of hypoxemia and improve patient outcomes after esophageal surgery.

Although LPVS is considered critical in the protective effect on the lungs, the risk analysis revealed a negative result in preventing intraoperative hypoxemia during OLV. The authors propose two primary reasons for the paradoxical results. First, the LPVS protocol was not performed completely by the respondents enrolled in this survey. The discrepancy between the “recognized LPVS” and their “self-perceived LPVS” should not be ignored. Specifically, more convincing evidence is needed to support the current concept of LPVSs, and consensus or guidelines with respect to LPVSs during OLV are still lacking. Second, patients at low risk for PPCs after thoracic surgery may not benefit from LPVS [55]. The mechanical power, first described in 2016, might be another novel key factor for PPCs and reflects the energy transmitted from the ventilator to the lung [56].

There were several limitations in this study. First, the data from the questionnaire-based survey were completely subjective, which might introduce bias into the findings. Second, owing to constraints on the response time, the questionnaire did not include more detailed information, such as short-term and long-term postoperative outcomes. Finally, the number of valid responses varied markedly among the provinces around China, potentially limiting its ability to accurately represent the current status of clinical practice in OLV.

Conclusions

As the second most populous country in the world, mainland China had only 92,726 anesthesiologists, or 6 to 7 anesthesiologists per 100,000 people in 2018. From 2015 to 2017, the workload of anesthesiologists in China increased by 10% [57]. Owing to their busy clinical workload, Chinese anesthesiologists often accept convenient ventilation strategies during OLV in cardiothoracic surgery. DLET intubation is usually applied to establish lung isolation. The majority of respondents perform low tidal volume, VCV mode, regular low-level PEEP, and manual recruitment maneuvers routinely during OLV. These findings indicate that the VCV mode during OLV may be associated with a reduced incidence of intraoperative hypoxemia in cardiothoracic surgery patients. A low SpO2 threshold of less than 85% during OLV may contribute to adverse outcomes, suggesting the need for early intervention in patients with oxygen desaturation during surgery. As the conventional ventilation strategy might be an independent risk factor for hypoxemia during OLV in esophageal surgery, LPV is routinely performed in esophageal surgery.

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

OLV:

One lung ventilation

DLET:

Double-lumen endotracheal tube

LPVS:

Lung protective ventilation strategies

PEEP:

Positive end-expiratory pressure

PPCs:

Postoperative pulmonary complications

HPV:

Hypoxic pulmonary vasoconstriction

VCV:

Volume control ventilation

SpO2 :

Saturation of peripheral oxygen

ETCO2 :

End-tidal carbon dioxide

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Acknowledgements

The authors are grateful to the reviewers and editor for their help and suggestions. The authors also thank Jian Huang, Cheng-hui Zhou, Hai-ling Wang, Zhong-rong Fang, peng-yu Qin, Lan Lan, Cong-jie Bi, Ying Chen, Xiao-ning Zhu, Liang Zhang, Nan Wang, Yi-ting Huang, Tao Sun, Yu-guang Bai, Hong-mei Ma, Shao-sheng Wu and all the other colleagues in the medical community who participated in the study.

Funding

This project is funded by the Natural Science Foundation of Fujian Province (2021J01769) and Joint Funds for the Innovation of Science Innovation of Science and Technology, Fujian Province (2020Y9019).

Author information

Author notes

  1. Hong-jin Liu and Yong Lin contributed equally to this work.

Authors and Affiliations

  1. Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Xinquan Road 29, Fuzhou, Fujian, 350001, PR China

    Hong-jin Liu, Yong Lin & Mei-fang Chen

  2. Department of Physical Examination Center, Fujian Medical University Union Hospital, Xinquan Road 29, Fuzhou, Fujian, 350001, PR China

    Mei-fang Chen

  3. Department of Critical Care Medicine, Fujian Medical University Union Hospital, Xinquan Road 29, Fuzhou, Fujian, 350001, PR China

    Hui Zhang

  4. Department of Anesthesiology, Shandong Provincial Hospital Affiliated with Shandong First Medical University, Jinan, China

    Wang Li

  5. Department of Anesthesiology, The First People’s Hospital of Yulin, Yulin, China

    Hai Yang

  6. Department of Anesthesiology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, China

    Wen-yue Kang

  7. Department of Anesthesiology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China

    Pei-lei Guo

  8. Department of Anesthesia and Surgery, The Third People’s Hospital of Henan Province, Zhengzhou, China

    Xiao-hui Guo

  9. Department of Anesthesiology, Binzhou People’s Hospital, Binzhou, China

    Ning-ning Cheng

  10. Department of Anesthesiology, Shunde Hospital of South Medical University, Foshan, China

    Jie-chao Tan

  11. Department of Anesthesiology, Nanchong Hospital of Beijing Anzhen Hospital Capital Medical University, Sichuan, Nanchong, China

    Yi-na He

  12. Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China

    Si-si Chen

  13. Department of Anesthesiology, The Second Central Hospital of Baoding, Baoding, China

    Yan Mu

  14. Department of Anesthesiology, Liaocheng People’s Hospital, Liaocheng, China

    Xian-wen Liu

Authors
  1. Hong-jin Liu
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  2. Yong Lin
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  3. Wang Li
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  4. Hai Yang
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  14. Hui Zhang
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  15. Mei-fang Chen
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Contributions

Hong-jin Liu and Yong LIN: Writing-original draft preparation and conceptualisation. Xiao-hui Guo, Ning-ning Chen, Jie-chao Tan, Yi-na He, Si-si Chen, Yan Mu: Data curation and visualisation. Wang Li and Xian-wen Liu: Investigation. Hai Yang and Pei-lei Guo: Methodology and Supervision. Wen-yue Kang: Software, Validation. Mei-fang CHEN and Hui Zhang: Supervision, writing, reviewing, and editing. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Hui Zhang or Mei-fang Chen.

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Ethics approval and consent to participate

This study was approved by the ethics committee of Fujian Medical University Union Hospital, and all participants provided written informed consent.

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Not applicable.

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The authors declare no competing interests.

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Liu, Hj., Lin, Y., Li, W. et al. Clinical practice of one-lung ventilation in mainland China: a nationwide questionnaire survey. BMC Anesthesiol 25, 7 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12871-024-02879-x

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BMC Anesthesiology

ISSN: 1471-2253

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