Journal article
Navigating Atelectasis: Utilizing Transpulmonary Pressure to Enhance Robotic Bronchoscopy
Journal of bronchology & interventional pulmonology, Vol.32(3), 01017
07/01/2025
DOI: 10.1097/LBR.0000000000001017
PMID: 40591660
Abstract
Background:Robotic navigation bronchoscopy (RNB) is effective for accessing peripheral lung lesions with precision and safety. However, the incidence of atelectasis during RNB can impede lesion identification. Higher positive end-expiratory pressure (PEEP) levels may mitigate atelectasis, but bedside assessment is challenging. Transpulmonary pressure (Ptp) assessment, proven useful in optimizing PEEP in ARDS, remains unexplored in RNB.Methods:This single-center, prospective study enrolled 21 consecutive patients undergoing RNB. All patients were paralyzed and ventilated equally, including PEEP 10 cmH2O and Vt 6 to 8 cc/kg of ideal body weight, and had an esophageal balloon placed using established techniques. Once an adequate esophageal pressure (Pes) waveform was identified, the Pes was recorded. We used Pes as a surrogate for intrathoracic pressure to calculate Ptp.Results:A total of 21 patients were enrolled (male 11, 52%), BMI (27 +/- 4.1). The mean nodule size was 26.83 +/- 9.33 mm. The diagnostic yield was 87% for malignancy. The mean Vt was 7.15 +/- 1.16 cc/kg. Mean Pes and Ptp were 9.64 +/- 3.76 cmH2O and 0.36 +/- 1.2 cmH2O, respectively. Eight patients had negative Ptp, and compared with patients with positive Ptp, there were more eccentric or no signals (75% vs. 45%) by rEBUS.Conclusion:This study provides detailed instructions and feasibility of assessing Ptp in patients undergoing RNB and highlights a potential relationship between negative Ptp and the ability to obtain a concentric rEBUS signal. Our findings suggest that negative Ptp may be associated with a higher likelihood of encountering eccentric or absent rEBUS signals. Further research could enhance our understanding of pulmonary physiology during RNB.
Details
- Title: Subtitle
- Navigating Atelectasis: Utilizing Transpulmonary Pressure to Enhance Robotic Bronchoscopy
- Creators
- Sevak Keshishyan - Englewood Hospital and Medical CenterJoseph Keenan - University of MinnesotaErhan H. Dincer - University of MinnesotaJennifer Wong - University of MinnesotaAbbie Begnaud - University of MinnesotaAlireza Nathani - University of MinnesotaHeidi Gibson - University of MinnesotaSudarshan Setty - University of MinnesotaRoy J. Cho - University of Minnesota
- Resource Type
- Journal article
- Publication Details
- Journal of bronchology & interventional pulmonology, Vol.32(3), 01017
- DOI
- 10.1097/LBR.0000000000001017
- PMID
- 40591660
- ISSN
- 1944-6586
- eISSN
- 1948-8270
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 4
- Language
- English
- Date published
- 07/01/2025
- Academic Unit
- Internal Medicine
- Record Identifier
- 9985179908202771
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