Adjuvant Transthoracic Negative-Pressure Ventilation in Nonintubated Thoracoscopic Surgery
Background: To minimize the risks of barotrauma during nonintubated thoracoscopic-surgery under spontaneous ventilation, we investigated an adjuvant transthoracic negative-pressure ventilation (NPV) method in patients operated on due to severe emphysema or interstitial lung disease. Methods: In this...
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MDPI AG
2023-06-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/13/4234 |
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| author | Riccardo Taje Eleonora Fabbi Roberto Sorge Stefano Elia Mario Dauri Eugenio Pompeo |
| author_facet | Riccardo Taje Eleonora Fabbi Roberto Sorge Stefano Elia Mario Dauri Eugenio Pompeo |
| author_sort | Riccardo Taje |
| collection | DOAJ |
| description | Background: To minimize the risks of barotrauma during nonintubated thoracoscopic-surgery under spontaneous ventilation, we investigated an adjuvant transthoracic negative-pressure ventilation (NPV) method in patients operated on due to severe emphysema or interstitial lung disease. Methods: In this retrospective study, NPV was employed for temporary low oxygen saturation and to achieve end-operative lung re-expansion during nonintubated lung volume reduction surgery (LVRS) for severe emphysema (30 patients, LVRS group) and in the nonintubated wedge resection of undetermined interstitial lung disease (30 patients, wedge-group). The results were compared following 1:1 propensity score matching with equivalent control groups undergoing the same procedures under spontaneous ventilation, with adjuvant positive-pressure ventilation (PPV) performed on-demand through the laryngeal mask. The primary outcomes were changes (preoperative–postoperative value) in the arterial oxygen tension/fraction of the inspired oxygen ratio (ΔPO<sub>2</sub>/FiO<sub>2</sub>;) and ΔPaCO<sub>2</sub>, and lung expansion completeness on a 24 h postoperative chest radiograph (CXR-score, 2: full or 1: incomplete). Results: Intergroup comparisons (NPV vs. PPV) showed no differences in demographic and pulmonary function. NPV could be accomplished in all instances with no conversion to general anesthesia with intubation. In the LVRS group, NPV improved ΔPO<sub>2</sub>/FiO<sub>2</sub> (9.3 ± 16 vs. 25.3 ± 30.5, <i>p</i> = 0.027) and ΔPaCO<sub>2</sub> (−2.2 ± 3.15 mmHg vs. 0.03 ± 0.18 mmHg, <i>p</i> = 0.008) with no difference in the CXR score, whereas in the wedge group, both ΔPO<sub>2</sub>/FiO<sub>2</sub> (3.1 ± 8.2 vs. 9.9 ± 13.8, <i>p</i> = 0.035) and the CXR score (1.9 ± 0.3 vs. 1.6 ± 0.5, <i>p</i> = 0.04) were better in the NPV subgroup. There was no mortality and no intergroup difference in morbidity. Conclusions: In this retrospective study, NITS with adjuvant transthoracic NPV resulted in better 24 h oxygenation measures than PPV in both the LVRS and wedge groups, and in better lung expansion according to the CXR score in the wedge group. |
| first_indexed | 2024-03-11T01:38:20Z |
| format | Article |
| id | doaj.art-a8f075613edb4b52941e080c491962ba |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-11T01:38:20Z |
| publishDate | 2023-06-01 |
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| series | Journal of Clinical Medicine |
| spelling | doaj.art-a8f075613edb4b52941e080c491962ba2023-11-18T16:50:56ZengMDPI AGJournal of Clinical Medicine2077-03832023-06-011213423410.3390/jcm12134234Adjuvant Transthoracic Negative-Pressure Ventilation in Nonintubated Thoracoscopic SurgeryRiccardo Taje0Eleonora Fabbi1Roberto Sorge2Stefano Elia3Mario Dauri4Eugenio Pompeo5Department of Thoracic Surgery, Policlinico Tor Vergata University, V.le Oxford 81, 00133 Rome, ItalyDepartment of Anesthesia and Intensive Care, Policlinico Tor Vergata University, V.le Oxford 81, 00133 Rome, ItalyDepartment of Biostatistics, Tor Vergata University of Rome, 00133 Rome, ItalyDepartment of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, ItalyDepartment of Anesthesia and Intensive Care, Policlinico Tor Vergata University, V.le Oxford 81, 00133 Rome, ItalyDepartment of Thoracic Surgery, Policlinico Tor Vergata University, V.le Oxford 81, 00133 Rome, ItalyBackground: To minimize the risks of barotrauma during nonintubated thoracoscopic-surgery under spontaneous ventilation, we investigated an adjuvant transthoracic negative-pressure ventilation (NPV) method in patients operated on due to severe emphysema or interstitial lung disease. Methods: In this retrospective study, NPV was employed for temporary low oxygen saturation and to achieve end-operative lung re-expansion during nonintubated lung volume reduction surgery (LVRS) for severe emphysema (30 patients, LVRS group) and in the nonintubated wedge resection of undetermined interstitial lung disease (30 patients, wedge-group). The results were compared following 1:1 propensity score matching with equivalent control groups undergoing the same procedures under spontaneous ventilation, with adjuvant positive-pressure ventilation (PPV) performed on-demand through the laryngeal mask. The primary outcomes were changes (preoperative–postoperative value) in the arterial oxygen tension/fraction of the inspired oxygen ratio (ΔPO<sub>2</sub>/FiO<sub>2</sub>;) and ΔPaCO<sub>2</sub>, and lung expansion completeness on a 24 h postoperative chest radiograph (CXR-score, 2: full or 1: incomplete). Results: Intergroup comparisons (NPV vs. PPV) showed no differences in demographic and pulmonary function. NPV could be accomplished in all instances with no conversion to general anesthesia with intubation. In the LVRS group, NPV improved ΔPO<sub>2</sub>/FiO<sub>2</sub> (9.3 ± 16 vs. 25.3 ± 30.5, <i>p</i> = 0.027) and ΔPaCO<sub>2</sub> (−2.2 ± 3.15 mmHg vs. 0.03 ± 0.18 mmHg, <i>p</i> = 0.008) with no difference in the CXR score, whereas in the wedge group, both ΔPO<sub>2</sub>/FiO<sub>2</sub> (3.1 ± 8.2 vs. 9.9 ± 13.8, <i>p</i> = 0.035) and the CXR score (1.9 ± 0.3 vs. 1.6 ± 0.5, <i>p</i> = 0.04) were better in the NPV subgroup. There was no mortality and no intergroup difference in morbidity. Conclusions: In this retrospective study, NITS with adjuvant transthoracic NPV resulted in better 24 h oxygenation measures than PPV in both the LVRS and wedge groups, and in better lung expansion according to the CXR score in the wedge group.https://www.mdpi.com/2077-0383/12/13/4234nonintubated thoracic surgeryVATSspontaneous ventilationemphysemainterstitial lung disease |
| spellingShingle | Riccardo Taje Eleonora Fabbi Roberto Sorge Stefano Elia Mario Dauri Eugenio Pompeo Adjuvant Transthoracic Negative-Pressure Ventilation in Nonintubated Thoracoscopic Surgery Journal of Clinical Medicine nonintubated thoracic surgery VATS spontaneous ventilation emphysema interstitial lung disease |
| title | Adjuvant Transthoracic Negative-Pressure Ventilation in Nonintubated Thoracoscopic Surgery |
| title_full | Adjuvant Transthoracic Negative-Pressure Ventilation in Nonintubated Thoracoscopic Surgery |
| title_fullStr | Adjuvant Transthoracic Negative-Pressure Ventilation in Nonintubated Thoracoscopic Surgery |
| title_full_unstemmed | Adjuvant Transthoracic Negative-Pressure Ventilation in Nonintubated Thoracoscopic Surgery |
| title_short | Adjuvant Transthoracic Negative-Pressure Ventilation in Nonintubated Thoracoscopic Surgery |
| title_sort | adjuvant transthoracic negative pressure ventilation in nonintubated thoracoscopic surgery |
| topic | nonintubated thoracic surgery VATS spontaneous ventilation emphysema interstitial lung disease |
| url | https://www.mdpi.com/2077-0383/12/13/4234 |
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