"Lateral decubitus strategy (LADS) is superior to ventilatory strategy (VESPA) in preventing atelectasis from obscuring targets during robotic bronchoscopy, leading to improved procedural outcomes" (LADS vs VESPA trial)

Joshua M. Boster, Department of Pulmonary Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland.
Mike Goertzen, Department of Pulmonary Medicine, Brooke Army Medical Center, Fort Sam Houston, TX.
Mona Sarkiss, Department of Anesthesia and Peri-Operative Medicine. The University of Texas MD Anderson Cancer Center. Houston, Texas.
Aristides J. Armas Villalba, Interventional Pulmonology - Methodist Advanced Lung Center, MHS and Texas IPS. San Antonio, Texas.
Bharat S. Bandari, Advocate Health - Midwest
Juhee Song, Department of Biostatistics. The University of Texas MD Anderson Cancer Center. Houston, Texas.
Carlos A. Jimenez, Department of Pulmonary Medicine. The University of Texas MD Anderson Cancer Center. Houston, Texas.
Bruce F. Sabath, Department of Pulmonary Medicine. The University of Texas MD Anderson Cancer Center. Houston, Texas.
Julie Lin, Department of Pulmonary Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland.
Horiana B. Grosu, Department of Pulmonary Medicine. The University of Texas MD Anderson Cancer Center. Houston, Texas.
David E. Ost, Department of Pulmonary Medicine. The University of Texas MD Anderson Cancer Center. Houston, Texas.
George A. Eapen, Department of Pulmonary Medicine. The University of Texas MD Anderson Cancer Center. Houston, Texas.
Gouthami Chintalapani, Siemens Medical Solutions USA Inc., Malvern, PA.
Roberto F. Casal, Department of Pulmonary Medicine. The University of Texas MD Anderson Cancer Center. Houston, Texas. Electronic address: rfcasal@mdanderson.org.

Abstract

Background: Atelectasis during peripheral bronchoscopy can cause CT-to body divergence, false positive radial-probe endobronchial ultrasound images, and can obscure a target. As shown in prior studies, ventilatory strategies to prevent atelectasis, though useful, cannot completely avoid this phenomenon.

Research question: Is a lateral decubitus superior to a ventilatory strategy in preventing atelectasis from obscuring targets in patients with lung nodules in dependent zones?

Study design and methods: Randomized controlled study (1:1) in which patients undergoing robotic bronchoscopy for nodules ≤ 3 cm in dependent lung zones were randomized to lateral decubitus strategy (LADS) vs. a ventilatory strategy to prevent atelectasis (VESPA). Patients who developed atelectasis obscuring the target crossed over to the opposite arm. Primary outcome was the development of atelectasis obscuring the target detected with m-CBCT. Secondary endpoints included tool in lesion (TIL), diagnostic yield (DY), and safety.

Results: 62 patients were analyzed, 29 in LADS and 33 in VESPA. No patients developed atelectasis obscuring target in LADS, and 9 patients did in VESPA (27.3%, 95% CI, 13.3%-45.5%) (p=0.002). TIL was achieved in 29 patients (100%, 95%CI 88.1%-100%) in LADS and in 24 patients (72.7%, 95% CI 54.5%-86.7%) in VESPA (p=0.005). DY on index biopsy was made in 25 patients (86.2%, 95% CI 68.3%-96.1%) in LADS and 19 patients (57.6%, 95% CI 39.2%-74.5%) in VESPA (p=0.026). In all 9 patients who crossed over from VESPA to LADS, atelectasis was eliminated leading to TIL, and diagnosis was obtained in 7 (78%). There were no major complications and no differences in the rate of minor complications.

Document Type

Article

PubMed ID

41513124

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