Severity of Atelectasis during Bronchoscopy: Descriptions of a New Grading System (<u>A</u>telectasi<u>s</u> <u>Se</u>verity <u>S</u>coring <u>S</u>ystem—“ASSESS”) and At-Risk-Lung Zones
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 image...
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| Format: | Article |
| Language: | English |
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MDPI AG
2024-01-01
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| Series: | Diagnostics |
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| Online Access: | https://www.mdpi.com/2075-4418/14/2/197 |
| _version_ | 1797344321319469056 |
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| author | Asad Khan Sami Bashour Bruce Sabath Julie Lin Mona Sarkiss Juhee Song Ala-Eddin S. Sagar Archan Shah Roberto F. Casal |
| author_facet | Asad Khan Sami Bashour Bruce Sabath Julie Lin Mona Sarkiss Juhee Song Ala-Eddin S. Sagar Archan Shah Roberto F. Casal |
| author_sort | Asad Khan |
| collection | DOAJ |
| description | 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) (<i>p</i> = 0.0098), and VESPA was associated with decreased odds (0.05; 95% CI, 0.01–0.47) (<i>p</i> = 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. |
| first_indexed | 2024-03-08T11:00:41Z |
| format | Article |
| id | doaj.art-f406f625f6ec463a9ba94ed538a8fe72 |
| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-08T11:00:41Z |
| publishDate | 2024-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-f406f625f6ec463a9ba94ed538a8fe722024-01-26T16:01:49ZengMDPI AGDiagnostics2075-44182024-01-0114219710.3390/diagnostics14020197Severity of Atelectasis during Bronchoscopy: Descriptions of a New Grading System (<u>A</u>telectasi<u>s</u> <u>Se</u>verity <u>S</u>coring <u>S</u>ystem—“ASSESS”) and At-Risk-Lung ZonesAsad Khan0Sami Bashour1Bruce Sabath2Julie Lin3Mona Sarkiss4Juhee Song5Ala-Eddin S. Sagar6Archan Shah7Roberto F. Casal8Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USADepartment of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USADepartment of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USADepartment of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USADepartment of Anesthesia and Peri-Operative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USADepartment of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USADepartment of Internal Medicine, King Faisal Specialist Hospital and Research Center, Madinah 42523, Saudi ArabiaDepartment of Onco-Medicine, Banner MD Anderson Cancer Center, Gilbert, AZ 85234, USADepartment of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USAAtelectasis 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) (<i>p</i> = 0.0098), and VESPA was associated with decreased odds (0.05; 95% CI, 0.01–0.47) (<i>p</i> = 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.https://www.mdpi.com/2075-4418/14/2/197atelectasisbronchoscopygeneral anesthesia |
| spellingShingle | Asad Khan Sami Bashour Bruce Sabath Julie Lin Mona Sarkiss Juhee Song Ala-Eddin S. Sagar Archan Shah Roberto F. Casal Severity of Atelectasis during Bronchoscopy: Descriptions of a New Grading System (<u>A</u>telectasi<u>s</u> <u>Se</u>verity <u>S</u>coring <u>S</u>ystem—“ASSESS”) and At-Risk-Lung Zones Diagnostics atelectasis bronchoscopy general anesthesia |
| title | Severity of Atelectasis during Bronchoscopy: Descriptions of a New Grading System (<u>A</u>telectasi<u>s</u> <u>Se</u>verity <u>S</u>coring <u>S</u>ystem—“ASSESS”) and At-Risk-Lung Zones |
| title_full | Severity of Atelectasis during Bronchoscopy: Descriptions of a New Grading System (<u>A</u>telectasi<u>s</u> <u>Se</u>verity <u>S</u>coring <u>S</u>ystem—“ASSESS”) and At-Risk-Lung Zones |
| title_fullStr | Severity of Atelectasis during Bronchoscopy: Descriptions of a New Grading System (<u>A</u>telectasi<u>s</u> <u>Se</u>verity <u>S</u>coring <u>S</u>ystem—“ASSESS”) and At-Risk-Lung Zones |
| title_full_unstemmed | Severity of Atelectasis during Bronchoscopy: Descriptions of a New Grading System (<u>A</u>telectasi<u>s</u> <u>Se</u>verity <u>S</u>coring <u>S</u>ystem—“ASSESS”) and At-Risk-Lung Zones |
| title_short | Severity of Atelectasis during Bronchoscopy: Descriptions of a New Grading System (<u>A</u>telectasi<u>s</u> <u>Se</u>verity <u>S</u>coring <u>S</u>ystem—“ASSESS”) and At-Risk-Lung Zones |
| title_sort | severity of atelectasis during bronchoscopy descriptions of a new grading system u a u telectasi u s u u se u verity u s u coring u s u ystem assess and at risk lung zones |
| topic | atelectasis bronchoscopy general anesthesia |
| url | https://www.mdpi.com/2075-4418/14/2/197 |
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