Superiority of Lateral Decubitus Strategy in Preventing Atelectasis From Obscuring Targets During Robotic Bronchoscopy: Lateral Decubitus Strategy vs Ventilatory Strategy to Prevent Atelectasis Trial.

Abstract

Atelectasis during peripheral bronchoscopy can cause CT-to-body divergence, can cause false-positive radial-probe endobronchial ultrasound images, and can obscure a target. As shown in prior studies, ventilatory strategies to prevent atelectasis, although useful, cannot completely avoid this phenomenon. Is a lateral decubitus superior to a ventilatory strategy in preventing atelectasis from obscuring targets in patients with lung nodules in dependent zones? This was a 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 mobile cone-beam CT scan. Secondary end points included tool in lesion (TIL), diagnostic yield, and safety. A total of 62 patients were analyzed: 29 in LADS and 33 in VESPA. No patients developed atelectasis obscuring target in the LADS group, and 9 patients did in the VESPA group (27.3%; 95% CI, 13.3%-45.5%; P = .002). TIL was achieved in 29 patients (100%; 95% CI, 88.1%-100%) in the LADS group and in 24 patients (72.7%; 95% CI, 54.5%-86.7%) in the VESPA group (P = .005). Diagnostic yield on index biopsy was made in 25 patients (86.2%; 95% CI, 68.3%-96.1%) in the LADS group and 19 patients (57.6%; 95% CI, 39.2%-74.5%) in the VESPA group (P = .026). In all 9 patients who crossed over from the VESPA group to the LADS group, 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. Our results suggest that LADS is superior to VESPA in preventing atelectasis from obscuring targets in patients with nodules located in dependent areas, can help eliminate atelectasis, is safe, and is also associated with better procedural outcomes such as TIL and diagnostic yield. ClinicalTrials.gov; No.: NCT05714033; URL: www. gov.