Rozéet al .1discuss the problem of hypoxemia during one-lung ventilation in a very constructive way but omit the option of increasing the concentration of oxygen in the shunt. Their case report illustrates the difficulty that sometimes arises.

If the concentration of oxygen in the shunt is increased, the same shunt causes less arterial desaturation. Because the amount of oxygen is quite small, a small volume, e.g. , 50 ml with a low inflation rate, e.g. , 6 breaths/min of the nonventilated lung can greatly improve arterial oxygenation. This simple technique was described in 2009 and usually caused marked improvement in oxygenation without disrupting surgery on the nonventilated lung.2 

Royal Adelaide Hospital, Adelaide, South Australia, Australia.

Rozé H, Lafargue M, Ouattara A: Case scenario: Management of intraoperative hypoxemia during one-lung ventilation. Anesthesiology 2011; 114:167–74
Russell WJ: Intermittent positive airway pressure to manage hypoxia during one-lung anaesthesia. Anaesth Intensive Care 2009; 37:432–4