Preventing atelectasis during bronchoscopy under general anesthesia

Abstract

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.

Selecting the Optimal Strategy to Prevent Atelectasis During Bronchoscopy

“…Regardless of the ventilatory strategy (VESPA or LNVP), it seems that roughly a quarter of the patients can still develop atelectasis making positional strategies that completely mitigate this phenomenon a valuable option in patients with lesions located in dependent areas. 8,9 A randomized trial of "lateral decubitus strategy" versus VESPA in patients undergoing robotic bronchoscopy for posteriorly located lesions is underway (NCT05-714033). To finalize, it is important to remember that not all patients are prone to atelectasis (ie, low body mass index, patients with emphysema and air-trapping) and prevention strategies should only be considered for those patients at risk.…”