Application of Continuous Positive Airway Pressure During Video-Assisted Thoracoscopic Surgery

Area of Science:

• Thoracic Surgery
• Anesthesiology
• Pulmonary Physiology

Background:

• Video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS) are standard for early-stage lung cancer resection.
• One-lung ventilation (OLV) is essential for these procedures but can cause hypoxemia due to intrapulmonary shunting.
• Continuous positive airway pressure (CPAP) is a potential intervention to mitigate hypoxemia during OLV.

Purpose of the Study:

• To review the lung physiology of OLV.
• To examine the application of CPAP in VATS/RATS during supine and lateral positions.
• To discuss CPAP use in COVID-19 patients during OLV.

Main Methods:

• Literature review of studies on OLV, hypoxemia, and CPAP.
• Analysis of CPAP efficacy in different patient positions (supine vs. lateral).
• Inclusion of data on CPAP use in the context of COVID-19.

Main Results:

• CPAP demonstrated benefits in improving oxygenation during OLV in the lateral decubitus position.
• No significant improvement in oxygenation was observed with CPAP during OLV in the supine position.
• Evidence suggests CPAP is a viable option for managing hypoxemia in specific surgical contexts.

Conclusions:

• CPAP applied to the non-dependent lung is a recognized strategy for treating hypoxemia during VATS and RATS.
• The effectiveness of CPAP is position-dependent, with greater benefits in the lateral position.
• Further research may explore optimized CPAP strategies for diverse patient populations, including those with COVID-19.