Ventilatory Strategy to Prevent Atelectasis During Bronchoscopy Under General Anesthesia: A Multicenter Randomized Controlled Trial (Ventilatory Strategy to Prevent Atelectasis -VESPA- Trial)

Moiz Salahuddin, Mona Sarkiss, Ala Eddin S. Sagar, Ioannis Vlahos, Christopher H. Chang, Archan Shah, Bruce F. Sabath, Julie Lin, Juhee Song, Teresa Moon, Peter H. Norman, George A. Eapen, Horiana B. Grosu, David E. Ost, Carlos A. Jimenez, Gouthami Chintalapani, Roberto F. Casal

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

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: Can a ventilatory strategy reduce the incidence of atelectasis during bronchoscopy under general anesthesia? Study Design and Methods: Randomized controlled study (1:1) in which patients undergoing bronchoscopy were randomized to receive standard ventilation (laryngeal mask airway, 100% FIO2, zero positive end-expiratory pressure [PEEP]) vs a ventilatory strategy to prevent atelectasis (VESPA) with endotracheal intubation followed by a recruitment maneuver, FIO2 titration (< 100%), and PEEP of 8 to 10 cm H2O. All patients underwent chest CT imaging and a survey for atelectasis with RP-EBUS bilaterally on bronchial segments 6, 9, and 10 after artificial airway insertion (time 1) and 20 to 30 min later (time 2). Chest CT scans were reviewed by a blinded chest radiologist. RP-EBUS images were assessed by three independent, blinded readers. The primary end point was the proportion of patients with any atelectasis (either unilateral or bilateral) at time 2 according to chest CT scan findings. 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: 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: ClinicalTrials.gov; No.: NCT04311723; URL: www.clinicaltrials.gov;

Original languageEnglish (US)
Pages (from-to)1393-1401
Number of pages9
JournalChest
Volume162
Issue number6
DOIs
StatePublished - Dec 2022

Keywords

  • atelectasis
  • bronchoscopy
  • general anesthesia

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

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