Out of the Box Thinking

Bhadra, Krish; Condra, William; Setser, Randolph M.

doi:10.1097/lbr.0000000000000822

Cited by 3 publications

(3 citation statements)

References 9 publications

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“…Bhadra et al described CBCT guided bronchoscopy in one patient who was placed in a prone position for a second bronchoscopic procedure after initial bronchoscopy noted atelectasis in the supine position ( 34 ). The second procedure (in prone position) demonstrated no atelectasis.…”

Section: Strategies To Mitigate the Development Of Intraprocedural At...mentioning

confidence: 99%

Preventing atelectasis during bronchoscopy under general anesthesia

Khan¹,

Bashour²,

Casal³

2023

J Thorac Dis

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Atelectasis is a well-defined phenomenon in patients having surgery under general anesthesia. Recently, this phenomenon was also reported in patients having bronchoscopy under general anesthesia, with dedicated studies demonstrating a high incidence of up to 89%. Not surprisingly, time under general anesthesia and a higher body mass index (BMI) were found to be two significant factors that influenced the development of intraprocedural atelectasis. Atelectasis poses a significant obstacle in peripheral bronchoscopy since it can result in false positive radial probe ultrasound images, create computed tomography to body divergence, as well as obscure the target lesion on intraprocedural cone beam computed tomography (CBCT) images, thereby affecting both the navigational and diagnostic yield of the procedure. Bronchoscopists should be aware of this phenomenon and make efforts to prevent it when peripheral bronchoscopy under general anesthesia is planned. Ventilatory strategies to reduce intraprocedural atelectasis have been studied and proven to be effective and well-tolerated. Other strategies, such as patient positioning and preprocedural strategies have also been described but need further investigation. This article aims to summarize the recent history regarding the discovery and significance of intraprocedural atelectasis during bronchoscopy under general anesthesia and the various state-of-the-art strategies that have been proposed to mitigate the development of this entity.

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Section: Strategies To Mitigate the Development Of Intraprocedural At...mentioning

confidence: 99%

Preventing atelectasis during bronchoscopy under general anesthesia

Khan¹,

Bashour²,

Casal³

2023

J Thorac Dis

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“…There were no major differences in complications across the two groups, with reports of transient episodes of hypotension requiring vasopressors and no instances of pneumothorax or pneumomediastinum. In addition to ventilation strategies, current research is also evaluating patient positioning such as the impact of lateral decubitus or prone positioning to reduce intraoperative atelectasis [29,30]. Summary of the two studies is demonstrated in Table 1.…”

Section: Andandmentioning

confidence: 99%

Anesthetic considerations in interventional pulmonology

Sikachi,

Mishra,

Anders

2023

Current Opinion in Pulmonary Medicine

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Purpose of review In this review, we highlight the important anesthetic consideration that relate to interventional bronchoscopic procedures for the management of central airway obstruction due to anterior mediastinal masses, endoluminal endobronchial obstruction, peripheral bronchoscopy for diagnosis and treatment of lung nodules, bronchoscopic lung volume reduction and medical pleuroscopy for diagnosis and management of pleural diseases. Recent findings The advent of the field of Interventional Pulmonology has allowed for minimally invasive options for patients with a wide range of lung diseases which at times have replaced more invasive surgical procedures. Ongoing research has shed light on advancement in anesthetic techniques and management strategies that have increased the safety during peri-operative management during these complex procedures. Current evidence focusing on the anesthetic techniques is presented here. Summary The field of Interventional Pulmonology requires a tailored anesthetic approach. Recent advancements and ongoing research have focused on expanding the partnership between the anesthesiologist and interventional pulmonologists which has led to improved outcomes for patients undergoing these procedures.

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“…A multicenter randomized controlled trial of standard fluoroscopy-guided bronchoscopy versus a thin bronchoscope with RP-EBUS conducted by Tanner and coworkers reported one of the greatest gaps between navigation (97%) and diagnostic yield (50%), which could be partly explained by atelectasis and false-positive images [13]. Thus, ventilatory and positional strategies have been proposed in order to prevent this unwanted phenomenon [14][15][16][17][18][19][20]. The VESPA trial (Ventilatory Strategy to Prevent Atelectasis) was a multicenter randomized controlled trial which compared standard ventilation through a laryngeal mask airway (LMA) with a 100% fraction of inspired oxygen (FiO 2 ) and a positive end-expiratory pressure (PEEP) of 0 cm H2O vs. VESPA, consisting of endotracheal intubation followed by a recruitment maneuver, FiO 2 titration (<100%), and a PEEP of 8-10 cm H 2 O [14].…”

Section: Introductionmentioning

confidence: 99%

Severity of Atelectasis during Bronchoscopy: Descriptions of a New Grading System (Atelectasis Severity Scoring System—“ASSESS”) and At-Risk-Lung Zones

Khan,

Bashour,

Sabath

et al. 2024

Diagnostics

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Atelectasis during bronchoscopy under general anesthesia is very common and can have a detrimental effect on navigational and diagnostic outcomes. While the intraprocedural incidence and anatomic location have been previously described, the severity of atelectasis has not. We reviewed chest CT images of patients who developed atelectasis in the VESPA trial (Ventilatory Strategy to Prevent Atelectasis). By drawing boundaries at the posterior chest wall (A), the anterior aspect of the vertebral body (C), and mid-way between these two lines (B), we delineated at-risk lung zones 1, 2, and 3 (from posterior to anterior). An Atelectasis Severity Score System (“ASSESS”) was created, classifying atelectasis as “mild” (zone 1), “moderate” (zones 1–2), and “severe” (zones 1–2–3). A total of 43 patients who developed atelectasis were included in this study. A total of 32 patients were in the control arm, and 11 were in the VESPA arm; 20 patients (47%) had mild atelectasis, 20 (47%) had moderate atelectasis, and 3 (6%) had severe atelectasis. A higher BMI was associated with increased odds (1.5 per 1 unit change; 95% CI, 1.10–2.04) (p = 0.0098), and VESPA was associated with decreased odds (0.05; 95% CI, 0.01–0.47) (p = 0.0080) of developing moderate to severe atelectasis. ASSESS is a simple method used to categorize intra-bronchoscopy atelectasis, which allows for a qualitative description of this phenomenon to be developed. In the VESPA trial, a higher BMI was not only associated with increased incidence but also increased severity of atelectasis, while VESPA had the opposite effect. Preventive strategies should be strongly considered in patients with risk factors for atelectasis who have lesions located in zones 1 and 2, but not in zone 3.

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Out of the Box Thinking

Cited by 3 publications

References 9 publications

Preventing atelectasis during bronchoscopy under general anesthesia

Preventing atelectasis during bronchoscopy under general anesthesia

Anesthetic considerations in interventional pulmonology

Severity of Atelectasis during Bronchoscopy: Descriptions of a New Grading System (Atelectasis Severity Scoring System—“ASSESS”) and At-Risk-Lung Zones

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