PMC5424183_01
Restriction of left (dependent) lung expansion including the upper lobe of the left lung (arrow) during the inspiratory phase after an incision of the left mediastinal pleura.
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fig1
In the operative field, the left (dependent) lung contracted rapidly and its expansion was severely interrupted (Figure 1).
Changes of vital signs and ventilator settings in case  1. TV, tidal volume; PIP, peak inspiratory pressure; EtCO2, end-tidal carbon dioxide; MAP, mean arterial pressure; OLV, one-lung ventilation; DLV, double-lung ventilation.
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fig2
Although SpO2 was maintained at 98% with 50% oxygen, end-tidal CO2 (EtCO2) and PIP increased from 38 to 40 mmHg and 20 to 23 cmH2O, respectively (Figure 2).
PMC5424183_02
Changes of vital signs and ventilator settings in case  2. TV, tidal volume; PIP, peak inspiratory pressure; EtCO2, end-tidal carbon dioxide; MAP, mean arterial pressure; OLV, one-lung ventilation; DLV, double-lung ventilation.
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fig3
One hundred minutes after starting surgery, TV suddenly decreased from 550 mL to 160 mL, and SpO2 was decreased to 82% (Figure 3).