Ventilatory Strategy to Prevent Atelectasis During Bronchoscopy Under General Anesthesia: A Multicenter Randomized Controlled Trial (Ventilatory Strategy to Prevent Atelectasis -VESPA- Trial).
atelectasis
bronchoscopy
general anesthesia
Journal
Chest
ISSN: 1931-3543
Titre abrégé: Chest
Pays: United States
ID NLM: 0231335
Informations de publication
Date de publication:
Dec 2022
Dec 2022
Historique:
received:
16
03
2022
revised:
20
06
2022
accepted:
23
06
2022
pubmed:
9
7
2022
medline:
15
12
2022
entrez:
8
7
2022
Statut:
ppublish
Résumé
Atelectasis negatively influences peripheral bronchoscopy, increasing CT scan-body divergence, obscuring targets, and creating false-positive radial-probe endobronchial ultrasound (RP-EBUS) images. Can a ventilatory strategy reduce the incidence of atelectasis during bronchoscopy under general anesthesia? Randomized controlled study (1:1) in which patients undergoing bronchoscopy were randomized to receive standard ventilation (laryngeal mask airway, 100% Fio Seventy-six patients were analyzed, 38 in each group. The proportion of patients with any atelectasis according to chest CT scan at time 2 was 84.2% (95% CI, 72.6%-95.8%) in the control group and 28.9% (95% CI, 15.4%-45.9%) in the VESPA group (P < .0001). The proportion of patients with bilateral atelectasis at time 2 was 71.1% (95% CI, 56.6%-85.5%) in the control group and 7.9% (95% CI, 1.7%-21.4%) in the VESPA group (P < .0001). At time 2, 3.84 ± 1.67 (mean ± SD) bronchial segments in the control group vs 1.21 ± 1.63 in the VESPA group were deemed atelectatic (P < .0001). No differences were found in the rate of complications. VESPA significantly reduced the incidence of atelectasis, was well tolerated, and showed a sustained effect over time despite bronchoscopic nodal staging maneuvers. VESPA should be considered for bronchoscopy when atelectasis is to be avoided. ClinicalTrials.gov; No.: NCT04311723; URL: www. gov.
Sections du résumé
BACKGROUND
BACKGROUND
Atelectasis negatively influences peripheral bronchoscopy, increasing CT scan-body divergence, obscuring targets, and creating false-positive radial-probe endobronchial ultrasound (RP-EBUS) images.
RESEARCH QUESTION
OBJECTIVE
Can a ventilatory strategy reduce the incidence of atelectasis during bronchoscopy under general anesthesia?
STUDY DESIGN AND METHODS
METHODS
Randomized controlled study (1:1) in which patients undergoing bronchoscopy were randomized to receive standard ventilation (laryngeal mask airway, 100% Fio
RESULTS
RESULTS
Seventy-six patients were analyzed, 38 in each group. The proportion of patients with any atelectasis according to chest CT scan at time 2 was 84.2% (95% CI, 72.6%-95.8%) in the control group and 28.9% (95% CI, 15.4%-45.9%) in the VESPA group (P < .0001). The proportion of patients with bilateral atelectasis at time 2 was 71.1% (95% CI, 56.6%-85.5%) in the control group and 7.9% (95% CI, 1.7%-21.4%) in the VESPA group (P < .0001). At time 2, 3.84 ± 1.67 (mean ± SD) bronchial segments in the control group vs 1.21 ± 1.63 in the VESPA group were deemed atelectatic (P < .0001). No differences were found in the rate of complications.
INTERPRETATION
CONCLUSIONS
VESPA significantly reduced the incidence of atelectasis, was well tolerated, and showed a sustained effect over time despite bronchoscopic nodal staging maneuvers. VESPA should be considered for bronchoscopy when atelectasis is to be avoided.
TRIAL REGISTRY
BACKGROUND
ClinicalTrials.gov; No.: NCT04311723; URL: www.
CLINICALTRIALS
RESULTS
gov.
Identifiants
pubmed: 35803302
pii: S0012-3692(22)01227-2
doi: 10.1016/j.chest.2022.06.045
pii:
doi:
Banques de données
ClinicalTrials.gov
['NCT04311723']
Types de publication
Randomized Controlled Trial
Multicenter Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1393-1401Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2022 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.