Anesthesia considerations to reduce motion and atelectasis during advanced guided bronchoscopy
| Autor: | Krish Bhadra, Scott Skibo, Kelvin Lau, Michael A. Pritchett, Karen A. Phillips |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Pulmonary and Respiratory Medicine
Pulmonary Atelectasis medicine.medical_treatment Image-guided bronchoscopy General anesthesia Atelectasis Review Lung biopsy Anesthesia General Divergence law.invention Breath Holding Positive-Pressure Respiration Diseases of the respiratory system 03 medical and health sciences Patient safety 0302 clinical medicine Radial endobronchial ultrasound Bronchoscopy Electromagnetic navigation bronchoscopy law medicine Humans Intubation 030212 general & internal medicine Intraoperative Complications Lung Computed tomography RC705-779 medicine.diagnostic_test business.industry medicine.disease Tomosynthesis 030228 respiratory system Anesthesia Ventilation (architecture) Lung cancer Tomography X-Ray Computed business |
| Zdroj: | BMC Pulmonary Medicine, Vol 21, Iss 1, Pp 1-10 (2021) BMC Pulmonary Medicine |
| ISSN: | 1471-2466 |
| DOI: | 10.1186/s12890-021-01584-6 |
| Popis: | Partnership between anesthesia providers and proceduralists is essential to ensure patient safety and optimize outcomes. A renewed importance of this axiom has emerged in advanced bronchoscopy and interventional pulmonology. While anesthesia-induced atelectasis is common, it is not typically clinically significant. Advanced guided bronchoscopic biopsy is an exception in which anesthesia protocols substantially impact outcomes. Procedure success depends on careful ventilation to avoid excessive motion, reduce distortion causing computed tomography (CT)-to-body-divergence, stabilize dependent areas, and optimize breath-hold maneuvers to prevent atelectasis. Herein are anesthesia recommendations during guided bronchoscopy. An FiO2 of 0.6 to 0.8 is recommended for pre-oxygenation, maintained at the lowest tolerable level for the entire the procedure. Expeditious intubation (not rapid-sequence) with a larger endotracheal tube and non-depolarizing muscle relaxants are preferred. Positive end-expiratory pressure (PEEP) of up to 10–12 cm H2O and increased tidal volumes help to maintain optimal lung inflation, if tolerated by the patient as determined during recruitment. A breath-hold is required to reduce motion artifact during intraprocedural imaging (e.g., cone-beam CT, digital tomosynthesis), timed at the end of a normal tidal breath (peak inspiration) and held until pressures equilibrate and the imaging cycle is complete. Use of the adjustable pressure-limiting valve is critical to maintain the desired PEEP and reduce movement during breath-hold maneuvers. These measures will reduce atelectasis and CT-to-body divergence, minimize motion artifact, and provide clearer, more accurate images during guided bronchoscopy. Following these recommendations will facilitate a successful lung biopsy, potentially accelerating the time to treatment by avoiding additional biopsies. Application of these methods should be at the discretion of the anesthesiologist and the proceduralist; best medical judgement should be used in all cases to ensure the safety of the patient. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-021-01584-6. |
| Databáze: | OpenAIRE |
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