Postoperative pulmonary complications (PPCs) are a major concern for children undergoing thoracic surgery—especially when one-lung ventilation (OLV) is required. Unlike adults, children have unique respiratory anatomy and physiology that make them more vulnerable to lung complications after surgery. Predicting which children are at highest risk could be the key to safer recoveries and better outcomes.A new study published in BMC Anesthesiology breaks new ground by developing and validating a practical nomogram—a visual prediction tool—to estimate the risk of PPCs in pediatric patients. The research included 361 children who had thoracic surgery with OLV. The cohort was randomly divided into a training group to build the nomogram and a validation group to test its accuracy.The study began by analyzing 31 possible clinical and perioperative predictors, narrowing them down to four key risk factors through advanced statistical modeling. The four factors included: Preoperative neutrophil-to-lymphocyte ratio (NLR): An inflammation marker easily measured from a standard blood test. Intraoperative ventilation mode: The way the ventilator supports breathing during surgery, with pressure-control ventilation-volume guaranteed (PCV-VG) mode emerging as the safest. Maximum peak airway pressure (Ppeak) during OLV: High airway pressures can indicate more strain on the lungs. Minimum oxygenation index (OI) during OLV: Lower OI values suggest more difficulty in getting oxygen into the blood.By combining these factors, the nomogram provided a simple and objective way to estimate each child’s risk of PPCs. The tool demonstrated strong predictive power, with a C-index of 0.909 in training and 0.871 in validation, meaning it was highly accurate in distinguishing high-risk children from others.This nomogram is easy to use in clinical settings, relying on routinely collected data. It can help clinicians identify at-risk patients in advance and tailor interventions—such as optimizing the ventilation strategy or monitoring more closely—for those most likely to benefit. The study also found that using the PCV-VG ventilation mode during surgery may reduce the risk of complications compared to other methods.While this study marks a promising advance in pediatric airway management, the authors call for further multicenter research to validate the tool in different hospitals and populations, and to explore long-term outcomes beyond the first 72 hours after surgery.Bullet Points: Researchers developed a validated nomogram to predict lung complications in children after thoracic surgery with OLV. Four simple clinical factors—pre-op NLR, ventilation mode, peak airway pressure, and oxygenation index—drive the risk calculation. The tool showed high accuracy, making it practical for real-world pediatric care. Early identification of high-risk patients allows for targeted interventions and improved outcomes.Citation:Wang, L., Xiao, T., Du, Z., Chen, T., Pei, D., & Qu, S. (2025). Development and validation of a nomogram to pediatric postoperative pulmonary complications following thoracic surgery. BMC Anesthesiology, 25:255. https://doi.org/10.1186/s12871-025-03122-x