Awake or intubated surgery in diagnosis of interstitial lung diseases? A prospective study.
Journal
ERJ open research
ISSN: 2312-0541
Titre abrégé: ERJ Open Res
Pays: England
ID NLM: 101671641
Informations de publication
Date de publication:
Jul 2021
Jul 2021
Historique:
received:
31
08
2020
accepted:
29
04
2021
entrez:
8
7
2021
pubmed:
9
7
2021
medline:
9
7
2021
Statut:
epublish
Résumé
Risks associated with video-assisted surgical lung biopsy (VASLB) for interstitial lung disease (ILD) with endotracheal intubation and mechanical ventilation are not nil. Awake video-assisted surgical lung biopsy (Awake-VASLB) has been proposed as a method to obtain a precise diagnosis in several different thoracic diseases. To compare clinical outcomes of Awake-VASLB and Intubated-VASLB in patients with suspected ILDs. From June 2016 to February 2020, all patients submitted to elective VASLB for suspected ILD were included. Differences in outcomes between Awake-VASLB and Intubated-VASLB were assessed through univariable, multivariable-adjusted, and a propensity score-matched analysis. Awake-VASLB was performed in 66 out of 100 patients, while 34 underwent Intubated-VASLB. The Awake-VASLB resulted in a lower post-operative morbidity (OR 0.025; 95% CI 0.001-0.35; p=0.006), less unexpected intensive care unit admission, less need for rescue therapy for pain, a reduced surgical and anaesthesiologic time, a reduced chest drain duration, and a lower post-operative length of stay. Awake-VASLB in patients affected by ILD is feasible and seems safer than Intubated-VASLB.
Sections du résumé
BACKGROUND
BACKGROUND
Risks associated with video-assisted surgical lung biopsy (VASLB) for interstitial lung disease (ILD) with endotracheal intubation and mechanical ventilation are not nil. Awake video-assisted surgical lung biopsy (Awake-VASLB) has been proposed as a method to obtain a precise diagnosis in several different thoracic diseases.
OBJECTIVES
OBJECTIVE
To compare clinical outcomes of Awake-VASLB and Intubated-VASLB in patients with suspected ILDs.
METHODS
METHODS
From June 2016 to February 2020, all patients submitted to elective VASLB for suspected ILD were included. Differences in outcomes between Awake-VASLB and Intubated-VASLB were assessed through univariable, multivariable-adjusted, and a propensity score-matched analysis.
RESULTS
RESULTS
Awake-VASLB was performed in 66 out of 100 patients, while 34 underwent Intubated-VASLB. The Awake-VASLB resulted in a lower post-operative morbidity (OR 0.025; 95% CI 0.001-0.35; p=0.006), less unexpected intensive care unit admission, less need for rescue therapy for pain, a reduced surgical and anaesthesiologic time, a reduced chest drain duration, and a lower post-operative length of stay.
CONCLUSION
CONCLUSIONS
Awake-VASLB in patients affected by ILD is feasible and seems safer than Intubated-VASLB.
Identifiants
pubmed: 34235209
doi: 10.1183/23120541.00630-2020
pii: 00630-2020
pmc: PMC8255540
pii:
doi:
Types de publication
Journal Article
Langues
eng
Informations de copyright
Copyright ©The authors 2021.
Déclaration de conflit d'intérêts
Conflict of interest: F. Guerrera has nothing to disclose. Conflict of interest: L. Costardi has nothing to disclose. Conflict of interest: G.L. Rosboch has nothing to disclose. Conflict of interest: P. Lyberis has nothing to disclose. Conflict of interest: E. Ceraolo has nothing to disclose. Conflict of interest: P. Solidoro has served as investigator in clinical trials, consultant or speaker for Alfasigma, AstraZeneca, Boehringer Ingelheim, GSK, Menarini, Novartis, Chiesi, Guidotti & Malesci and ABC Farmaceutici outside this work. Conflict of interest: C. Filippini has nothing to disclose. Conflict of interest: G. Verri has nothing to disclose. Conflict of interest: L. Brazzi has nothing to disclose. Conflict of interest: C. Albera has nothing to disclose regarding this work, but has served as investigator in clinical trials, consultant, speaker, steering committee or scientific advisory board member for Bayer, Boehringer Ingelheim, FibroGen, Gilead, Grifols, GSK, Roche, MSD, Sanofi Aventis outside this work. Conflict of interest: E. Ruffini has nothing to disclose.
Références
Ann Thorac Surg. 2019 Oct;108(4):1045-1051
pubmed: 31181206
Eur Respir Rev. 2015 Mar;24(135):69-77
pubmed: 25726558
Sarcoidosis Vasc Diffuse Lung Dis. 2015 Sep 14;32(3):251-8
pubmed: 26422571
Lancet Respir Med. 2014 Dec;2(12):1007-15
pubmed: 25466352
Am J Respir Crit Care Med. 2004 Oct 15;170(8):904-10
pubmed: 15256390
Ann Transl Med. 2015 Mar;3(3):37
pubmed: 25815298
Eur J Cardiothorac Surg. 2015 Jun;47(6):1027-30; discussion 1030
pubmed: 25312521
Eur J Cardiothorac Surg. 2019 Jan 1;55(1):91-115
pubmed: 30304509
N Engl J Med. 2014 May 29;370(22):2071-82
pubmed: 24836310
Am J Respir Crit Care Med. 2016 May 15;193(10):1161-7
pubmed: 26646481
J Thorac Dis. 2017 Aug;9(8):2692-2696
pubmed: 28932577
Chest. 2020 Apr;157(4):1030-1042
pubmed: 31783014
J Thorac Cardiovasc Surg. 2015 May;149(5):1394-401.e1
pubmed: 25648484
Lancet Respir Med. 2020 Feb;8(2):147-157
pubmed: 31578169
J Thorac Dis. 2015 Oct;7(10):1719-24
pubmed: 26623093
J Arthroplasty. 2017 Aug;32(8):2390-2394
pubmed: 28413136
Ann Surg. 2004 Aug;240(2):205-13
pubmed: 15273542
Eur Respir J. 2019 Feb 21;53(2):
pubmed: 30792236
Lancet Respir Med. 2020 May;8(5):453-460
pubmed: 32145830
Lancet. 2011 May 21;377(9779):1760-9
pubmed: 21571362
Lancet. 2009 Jun 6;373(9679):1926-8
pubmed: 19375158
Am J Respir Crit Care Med. 2011 Mar 15;183(6):788-824
pubmed: 21471066
Lancet Respir Med. 2019 Feb;7(2):129-140
pubmed: 30224322
Lancet Respir Med. 2018 Feb;6(2):138-153
pubmed: 29154106
Anesthesiology. 2015 Sep;123(3):692-713
pubmed: 26120769
Eur Respir Rev. 2018 Sep 26;27(149):
pubmed: 30257909
J Thorac Dis. 2014 Jul;6(7):888-95
pubmed: 25093084
Eur J Anaesthesiol. 2017 Aug;34(8):492-507
pubmed: 28633157