So you navigate your way through a VATS case and feel like you have done a great job. They are now getting ready to close the chest and it will be less than 10 minutes. You have cut the gas off and started to reverse the patient.

In what is a miracle of perfect timing (or is it that you are just that good?) the patient starts to breath just as they start to put on the dressings.

You flip off the vent but the patient begins to desat. they are done and looking at you as you move the patient flat. The patient is still not ventilating well despite being 100% reversed and breathing well.

What did you forget check?