医学
肺不张
支气管镜检查
麻醉
机械通风
插管
气道
外科
放射科
肺
内科学
作者
Mohammad Salahuddin,Mona Sarkiss,Ala-Eddin S. Sagar,Ioannis Vlahos,Cheng-Hsien Chang,Amish P. Shah,Bruce F. Sabath,Julie Lin,Juhee Song,Teresa Moon,Peter H. Norman,George A. Eapen,Horiana B. Grosu,David Ost,Carlos A. Jiménez,Gouthami Chintalapani,Roberto F. Casal
出处
期刊:Chest
[Elsevier]
日期:2022-12-01
卷期号:162 (6): 1393-1401
被引量:20
标识
DOI:10.1016/j.chest.2022.06.045
摘要
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% 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.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.
科研通智能强力驱动
Strongly Powered by AbleSci AI