Abstract
Objective
Spontaneous ventilation video-assisted thoracic surgery (SV-VATS) is reported to have
superior or equal efficacy on postoperative recovery to mechanical ventilation VATS
(MV-VATS). However, perioperative safety of the SV-VATS blebectomy is not entirely
demonstrated.
Methods
We performed a noninferiority, randomized controlled trial (No. NCT03016858) for primary spontaneous pneumothorax patients aged 16 to 50 years undergoing a SV-VATS
and the MV-VATS procedure. The trial was conducted at 10 centers in China from April
2017 to January 2019. The primary outcome was the comparison of intra- and postoperative
complications between SV-VATS and MV-VATS procedures. Secondary outcomes included
total analgesia dose, change of vital sign during surgery, procedural duration, recovery
time, postoperative visual analog pain scores, and hospitalization length.
Results
In this study, 335 patients were included. There was no significant difference between
the SV-VATS group and the MV-VATS group in the intra- and postoperative complication
rates (17.90% vs 22.09%; relative risk, 0.81; 95% confidence interval, 0.52-1.26;
P = .346). The SV-VATS group was associated with significantly decreased total dose
of intraoperative opioid agents; that is, sufentanil (11.37 μg vs 20.92 μg; P < .001) and remifentanil (269.78 μg vs 404.96 μg; P < .001). The SV-VATS procedure was also associated with shorter extubation time (12.28 minutes
vs 17.30 minutes; P < .001), postanesthesia care unit recovery time (25.43 minutes vs 30.67 minutes;
P = .02) and food intake time (346.07 minute vs 404.02 minutes; P = .002). Moreover, the SV-VATS procedure deceased the anesthesia cost compared with
the MV-VATS ($297.81 vs $399.81; P < .001).
Conclusions
SV-VATS was shown to be noninferior to MV-VATS in term of complication rate and in
selected patients undergoing blebectomy for primary spontaneous pneumothorax.
Graphical abstract
Graphical Abstract
Key Words
Abbreviations and Acronyms:
BIS (bispectral index), LMA (laryngeal mask airways), MV (mechanical ventilation), MV-VATS (mechanical ventilation video-assisted thoracoscopic surgery), NLR (neutrophil to lymphocyte ratio), OLV (1-lung ventilation), PACU (postanesthesia care unit), PaCO2 (arterial carbon dioxide tension), PetCO2 (end tidal carbon dioxide pressure), PLR (platelet to lymphocyte ratio), PSP (primary spontaneous pneumothorax), RCT (randomized controlled trial), SpO2 (pulse oxygen saturation), SV-VATS (non-intubated spontaneous ventilation video-assisted thoracoscopic surgery), TCI (target-controlled infusion), VAS (visual analog scale), VATS (video-assisted thoracoscopic surgery)To read this article in full you will need to make a payment
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References
- Video-assisted thoracoscopic surgery is more favorable than thoracotomy for resection of clinical stage I non-small cell lung cancer.Ann Thorac Surg. 2007; 83: 1965-1970
- The effect of endotracheal tubes versus laryngeal mask airways on perioperative respiratory adverse events in infants: a randomised controlled trial.Lancet. 2017; 389: 701-708
- Association between driving pressure and development of postoperative pulmonary complications in patients undergoing mechanical ventilation for general anaesthesia: a meta-analysis of individual patient data.Lancet Respir Med. 2016; 4: 272-280
- Spontaneous ventilation thoracoscopic thymectomy without muscle relaxant for myasthenia gravis: comparison with “standard” thoracoscopic thymectomy.J Thorac Cardiovasc Surg. 2018; 155: 1882-1889.e3
- Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study.Lancet. 2020; 8: 475-481
- Opioid abuse or dependence increases 30-day readmission rates after major operating room procedures: a national readmissions database study.Anesthesiology. 2018; 128: 880-890
- Maintenance anaesthetics during remifentanil-based anaesthesia might affect postoperative pain control after breast cancer surgery.Br J Anaesth. 2010; 105: 661-667
- Anesthesia with nontracheal intubation in thoracic surgery.J Thorac Dis. 2012; 4: 126-130
- Non-intubated spontaneous ventilation in video-assisted thoracoscopic surgery: a meta-analysis.Eur J Cardiothorac Surg. 2020; 57: 428-437
- Thoracoscopic surgery for tracheal and carinal resection and reconstruction under spontaneous ventilation.J Thorac Cardiovasc Surg. 2018; 155: 2746-2754
- World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects.JAMA. 2013; 310: 2191-2194
- Spontaneous ventilation versus mechanical ventilation during video-assisted thoracoscopic surgery for spontaneous pneumothorax: a study protocol for multicenter randomized controlled trial.J Thorac Dis. 2020; 12: 1570-1581
- ERS task force statement: diagnosis and treatment of primary spontaneous pneumothorax.Eur Respir J. 2015; 46: 321-335
- Acceleromyography and mechanomyography for establishing potency of neuromuscular blocking agents: a randomized-controlled trial.Acta Anaesth Scand. 2009; 53: 449-454
- A simplified scoring system for the post-operative recovery room.Can Anaesth Soc J. 1975; 22: 111-113
- Zhonghua Liu Xing Bing Xue Za Zhi. 2016; 37: 741-744
- Lung injury after one-lung ventilation: a review of the pathophysiologic mechanisms affecting the ventilated and the collapsed lung.Anesth Analg. 2015; 121: 302-318
- Clinical characteristics of 2019 novel coronavirus infection in China.N Engl J Med. 2020; 382: 1708-1720
- Time course of lung changes on chest CT during recovery from 2019 novel coronavirus (COVID-19) pneumonia.Radiology. 2020; 295: 715-721
- Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome.N Engl J Med. 1998; 338: 347-354
- Surgical pneumothorax under spontaneous ventilation-effect on oxygenation and ventilation.Ann Transl Med. 2015; 3: 106
- Trends in the incidence and recurrence of inpatient-treated spontaneous pneumothorax, 1968-2016.JAMA. 2018; 320: 1471-1480
- Confidence intervals for predicted outcomes in regression models for categorical outcomes.Stata J. 2005; 5: 537-559
- Hypercapnic acidosis reduces oxidative reactions in endotoxin-induced lung injury.Anesthesiology. 2010; 113: 116-125
- Effect of therapeutic hypercapnia on inflammatory responses to one-lung ventilation in lobectomy patients.Anesthesiology. 2015; 122: 1235-1252
- Nonintubated video-assisted thoracoscopic surgery under epidural anesthesia compared with conventional anesthetic option: a randomized control study.Surg Innov. 2015; 22: 123-130
- The impact of spontaneous ventilation on non-operative lung injury in thoracic surgery: a randomized controlled rabbit model study.Eur J Cardiothorac Surg. 2017; 52: 1083-1089
- Immunological and inflammatory impact of non-intubated lung metastasectomy.Int J Mol Sci. 2017; 18: 1466
- Mild hypercapnia increases subcutaneous and colonic oxygen tension in patients given 80% inspired oxygen during abdominal surgery.Anesthesiology. 2006; 104: 944-949
- The impact of intra-operative sufentanil dosing on post-operative pain, hyperalgesia and morphine consumption after cardiac surgery.Eur J Pain. 2013; 17: 562-570
- Non-intubated thoracoscopic surgery using internal intercostal nerve block, vagal block and targeted sedation.Eur J Cardiothorac Surg. 2014; 46: 620-625
- The effect of pleural abrasion on the treatment of primary spontaneous pneumothorax: a systematic review of randomized controlled trials.PLoS One. 2015; 10: e0127857
- Thoracoscopic pleurodesis for primary spontaneous pneumothorax with high recurrence risk: a prospective randomized trial.Ann Surg. 2012; 255: 440-445
- Non-intubated thoracoscopic surgery for lung cancer in patients with impaired pulmonary function.Ann Transl Med. 2019; 7: 40
- Spontaneous ventilation video-assisted thoracoscopic surgery for patients with non-small-cell lung cancer with excess body weight.Eur J Cardiothorac Surg. 2020; 58: 605-612
- Non-intubated video-assisted thoracic surgery in patients aged 80 years and older.Ann Transl Med. 2015; 3: 101
Article info
Publication history
Published online: February 02, 2021
Accepted:
January 24,
2021
Received in revised form:
January 18,
2021
Received:
July 13,
2020
Footnotes
Supported by the Guangzhou Institute of Respiratory Disease.
Drs Liu, Liang, and Cui contributed equally to this article.
Identification
Copyright
© 2021 Published by Elsevier Inc. on behalf of The American Association for Thoracic Surgery
ScienceDirect
Access this article on ScienceDirectLinked Article
- Commentary: Relax and breatheThe Journal of Thoracic and Cardiovascular SurgeryVol. 163Issue 5
- PreviewThe multicenter randomized clinical trial reported by Liu and colleagues1 challenges the operative comfort zones of thoracic surgeons accustomed to selective positive pressure ventilation. For thoracic surgeons and anesthesiologists to relax enough to let their patients breathe spontaneously during minimally invasive surgery, sufficient equipoise and potential benefits are needed to stoke the desires for disruptive technologies.
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- Commentary: Striving for higher level of evidenceThe Journal of Thoracic and Cardiovascular SurgeryVol. 163Issue 5
- PreviewAs thoracic surgery has become less and less invasive, attention has also turned to minimizing complications from conventional mechanical ventilation during surgery, including intubation injury, ventilation-induced injury, and sequela of muscle relaxants and opioid analgesia. Spontaneous ventilation video-assisted thoracic surgery (SV-VATS) has emerged as a technique aimed to prevent these adverse effects of conventional mechanical ventilation video-assisted thoracic surgery.1 Liu and colleagues2 have performed a prospective randomized controlled trial to evaluate the perioperative safety and physiologic changes of these 2 ventilation strategies.
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