{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T12:02:48Z","timestamp":1789387368843,"version":"build-2803163510"},"reference-count":31,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:00:00Z","timestamp":1789344000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: Low regional cerebral oxygen saturation (rScO2) in children is linked to neurological sequelae. Lung-protective ventilation (LPV) mitigates lung injury but its effect on intraoperative rScO2 is uncertain. Methods: One hundred and four children (&lt;6 years) undergoing thoracoscopic mediastinal mass resection or lobectomy were randomized to LPV (n = 52; tidal volume: 6 mL\/kg double-lung ventilation [DLV], 4 mL\/kg one-lung ventilation [OLV] + 5 cm H2O PEEP) or Control (n = 52; 10 mL\/kg DLV, 8 mL\/kg OLV + zero PEEP). rScO2 was monitored continuously. Primary outcome was incidence of low rScO2 during OLV (\u226520% decrease from baseline \u22651 min). Secondary outcomes included lowest rScO2, postoperative pulmonary complications (PPCs), and hospital length of stay (LOS). Results: Ninety-six children were analyzed (n = 48\/group). Overall low rScO2 incidence during OLV was 25\/96 (26%). Significantly low rScO2 incidence occurred with LPV (7\/48, 14.6%) versus control (18\/48, 37.5%; p = 0.011). The lowest intraoperative rScO2 was significantly higher in the LPV group 76.5 (70.3, 80.0) compared to control 70.5 (60.3, 76.0); p &lt; 0.001. PPC incidence was lower with LPV (7\/48, 14.6%) than control (16\/48, 33.3%; p = 0.031). Postoperative LOS was shorter in the LPV group 4.0 [4.0\u20135.0] days versus control group 5.0 [4.3\u20136.0] days, p &lt; 0.001. Conclusions: Compared to conventional ventilation, an LPV strategy significantly reduces the incidence of low rScO2 during OLV in young children undergoing thoracoscopic surgery. LPV also decreases PPCs and shortens hospital stay. Clinical trial registration: ChiCTR2400092732.<\/jats:p>","DOI":"10.3390\/children13091243","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T10:19:41Z","timestamp":1789381181000},"page":"1243","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effect of Lung-Protective Ventilation on Changes in Regional Cerebral Oxygen Saturation During Thoracoscopic Surgery in Children: A Prospective, Single-Center, Randomized Controlled Trial"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4696-8733","authenticated-orcid":false,"given":"Guoliang","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Beijing Children\u2019s Hospital, Capital Medical University, National Center for Children\u2019s Health, Beijing 100045, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fang","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Beijing Children\u2019s Hospital, Capital Medical University, National Center for Children\u2019s Health, Beijing 100045, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5195-6270","authenticated-orcid":false,"given":"Lijing","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Beijing Children\u2019s Hospital, Capital Medical University, National Center for Children\u2019s Health, Beijing 100045, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiehua","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Beijing Children\u2019s Hospital, Capital Medical University, National Center for Children\u2019s Health, Beijing 100045, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhengzheng","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Beijing Children\u2019s Hospital, Capital Medical University, National Center for Children\u2019s Health, Beijing 100045, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianmin","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Beijing Children\u2019s Hospital, Capital Medical University, National Center for Children\u2019s Health, Beijing 100045, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"842","DOI":"10.1097\/ALN.0000000000003971","article-title":"Hypoxemia in Young Children Undergoing One-lung Ventilation: A Retrospective Cohort Study","volume":"135","author":"Templeton","year":"2021","journal-title":"Anesthesiology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1097\/ALN.0000000000004781","article-title":"Hypoxemia in school-age children undergoing one-lung ventilation: A retrospective cohort study from the Multicenter Perioperative Outcomes Group","volume":"140","author":"Templeton","year":"2024","journal-title":"Anesthesiology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1016\/j.bja.2019.02.013","article-title":"Lung protective ventilation during pulmonary resection in children: A prospective, single-centre, randomised controlled trial","volume":"122","author":"Lee","year":"2019","journal-title":"Br. 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