Thoracic surgery generally requires one-lung ventilation (OLV) to facilitate surgical exposure and tissue resection. 1-4 Contemporary airway devices for lung isolation include the double-lumen endotracheal tube (DLT), endobronchial placement of a single-lumen endotracheal tube, or placement of an endobronchial blocker through a single-lumen endotracheal tube. 1-5 The DLT is the most commonly used airway device for OLV because it enables rapid deflation of the isolated lung and suctioning of the airways of the deflated lung, and further allows for the application of continuous positive airway pressure (CPAP) in the event that significant hypoxemia occurs. 1-2 Unfortunately, not all thoracic surgery patients are candidates for DLT placement, and lung isolation may require endobronchial blocker insertion through a single-lumen endotracheal tube. 1,3-5 When hypoxemia develops during OLV in the setting of an endobronchial blocker, treatment options are limited. Considering that CPAP is the best therapy for hypoxemia when a DLT is employed for OLV, this strategy should be common practice when an endobronchial blocker is placed for OLV. We report a case of significant hypoxemia during OLV with an endobronchial blocker, and its management with CPAP application. A 44-year-old man with a left lower lobe lung mass presented for a video-assisted thoracoscopic wedge resection. The patient's medical history was unremarkable otherwise. Intraoperatively, standard American Society of Anesthesiologists monitors were placed and the patient was preoxygenated. General anesthesia was induced; however, intubation with a size 8.0-mm single-lumen endotracheal tube to facilitate bronchoscopy was challenging and required 2 intubation attempts. After completion of the bronchoscopy, we decided not to exchange the single-lumen tube for a DLT for safety reasons. A 9-F Cohen tip deflecting endobronchial blocker (Cook Medical, Bloomington, IN) (Fig 1) was placed in the left mainstem
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