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

As shown in prior studies, ventilatory strategies to prevent atelectasis, although useful, cannot completely avoid this phenomenon.

如先前研究所示，尽管有用，但预防肺不张的通气策略无法完全避免这一现象。

research_question

Is a lateral decubitus superior to a ventilatory strategy in preventing atelectasis from obscuring targets in patients with lung nodules in dependent zones?

在依赖区有肺结节的患者中，侧卧位是否优于通气策略以防止肺不张遮挡目标？

study_design_and_methods

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).

这是一项随机对照研究（1:1），对依赖区≤3厘米的结节进行机器人支气管镜检查的患者被随机分配到侧卧位策略（LADS）与防止肺不张的通气策略（VESPA）。

Patients who developed atelectasis obscuring the target crossed over to the opposite arm.

发展出遮挡目标的肺不张的患者转至对侧组。

Primary outcome was the development of atelectasis obscuring the target detected with mobile cone-beam CT scan.

主要结果是通过移动式锥形束CT扫描检测到的遮挡目标的肺不张的发展。

Secondary end points included tool in lesion (TIL), diagnostic yield, and safety.

次要终点包括肿瘤内工具(TIL)、诊断效率和安全性。

Results

A total of 62 patients were analyzed: 29 in LADS and 33 in VESPA.

共有62名患者被分析：其中29名在LADS组，33名在VESPA组。

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).

在LADS组中，没有患者出现遮挡目标的肺不张，而在VESPA组中有9名患者出现肺不张（27.3%；95% 置信区间，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).

在LADS组中，有29名患者（100%；95% 置信区间，88.1%-100%）达到了肿瘤浸润淋巴细胞（TIL），而在VESPA组中有24名患者（72.7%；95% 置信区间，54.5%-86.7%）达到了TIL（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).

在LADS组中，25名患者（86.2%；95% CI，68.3%-96.1%）在初次活检时诊断出阳性结果，而在VESPA组中，19名患者（57.6%；95% CI，39.2%-74.5%）初次活检时诊断出阳性结果（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%).

在所有9名从VESPA组转至LADS组的患者中，均消除了肺不张，实现了TIL，并且有7名患者（78%）获得了诊断。

There were no major complications and no differences in the rate of minor complications.

没有出现重大并发症，小并发症的发生率也没有差异。

interpretation

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.

我们的研究结果表明，与VESPA相比，LADS在防止位于依赖区域的结节患者发生肺不张从而模糊目标方面更为优越，可以帮助消除肺不张，是安全的，并且与更好的程序结果相关，如TIL和诊断效率。

clinical_trial_registration

ClinicalTrials.gov; No.: NCT05714033; URL: www.

ClinicalTrials.gov; 编号: NCT05714033; 网址: www.

clinicaltrials

gov.

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