{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T14:00:37Z","timestamp":1790258437039,"version":"4.1.0"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:00:00Z","timestamp":1783036800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"vor","delay-in-days":83,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Scientific Research Project of the Anhui Provincial Education Department","award":["Grant No. 2025AHGXZK40047"],"award-info":[{"award-number":["Grant No. 2025AHGXZK40047"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Anesthesiol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The reliability of end-tidal carbon dioxide (EtCO\u2082) as a surrogate for arterial arterial carbon dioxide partial pressure (PaCO\u2082) during one-lung ventilation (OLV) in infants is uncertain. This study evaluated EtCO\u2082-PaCO\u2082 agreement in infants undergoing OLV and identified factors associated with clinically significant discrepancy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This secondary analysis of a prospective, randomized controlled trial included 172 infants (aged\u2009\u2264\u20092 years) undergoing thoracoscopic surgery. Paired PaCO\u2082 and EtCO\u2082 measurements were obtained 20\u00a0min after initiating OLV. Clinical agreement was defined a priori as an absolute difference of \u2264\u20095 mmHg. Statistical evaluations included Bland\u2013Altman analysis and multivariable logistic regression to identify predictors of disagreement, and correlation analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      During OLV, the mean EtCO\u2082\u2013PaCO\u2082 bias was 2.8 mmHg with wide 95% limits of agreement (-4.7 to 10.3 mmHg), exceeding the clinically acceptable threshold. Oxygenation impairment (PaO\u2082\/FiO\u2082 &lt; 200 mmHg) significantly reduced the proportion of clinically acceptable measurements (55.9% vs. 81.7%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.0001). In multivariable analysis, EtCO\u2082\u2013PaCO\u2082 disagreement occurred exclusively in infants ventilated under the non\u2013protective protocol (VT 8 mL\/kg with ZEEP). After excluding ventilatory variables that were structurally confounded with randomized allocation, lower lung compliance was independently associated with disagreement (adjusted OR 1.66, 95% CI 1.05\u20132.64,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.030).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>EtCO\u2082 provides only limited reliability as a stand\u2013alone substitute for arterial blood gas analysis in infants during OLV, particularly under non\u2013protective ventilation. The lung\u2013protective ventilation strategy as a composite intervention is associated with substantially improved EtCO\u2082\u2013PaCO\u2082 agreement during OLV in infants. Among individual patient-level factors, lower lung compliance independently predicts EtCO\u2082\u2013PaCO\u2082 disagreement and may serve as a bedside indicator for clinicians to consider supplementary arterial blood gas analysis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12871-026-04077-3","type":"journal-article","created":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T12:21:26Z","timestamp":1783081286000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Reliability of end-tidal carbon dioxide as a surrogate for arterial carbon dioxide assessment in infants undergoing thoracoscopic surgery with one-lung ventilation"],"prefix":"10.1186","volume":"26","author":[{"given":"Change","family":"Zhu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sisi","family":"Wei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rufang","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mazhong","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rong","family":"Wei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,3]]},"reference":[{"key":"4077_CR1","first-page":"CD002061","volume":"2001","author":"PG Woodgate","year":"2001","unstructured":"Woodgate PG, Davies MW. 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The protocol for this secondary analysis was approved by the Ethics Committee of Shanghai Children\u2019s Hospital (Approval No. 2021R129- F02; Date of Approval: February 24, 2022).","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"576"}}