Navigating Atelectasis: Utilizing Transpulmonary Pressure to Enhance Robotic Bronchoscopy: A Single-Center,...

Area of Science:

• Pulmonary Medicine
• Interventional Pulmonology
• Respiratory Physiology

Background:

• Robotic navigation bronchoscopy (RNB) offers precision for peripheral lung lesion access.
• Atelectasis during RNB can hinder lesion identification.
• Optimizing positive end-expiratory pressure (PEEP) is challenging due to difficulties in bedside assessment.

Purpose of the Study:

• To assess the feasibility of transpulmonary pressure (Ptp) measurement during RNB.
• To explore the relationship between Ptp and robotic endobronchial ultrasound (rEBUS) signal quality.

Main Methods:

• Prospective study of 21 patients undergoing RNB.
• Esophageal balloon catheter used to measure esophageal pressure (Pes) as a surrogate for intrathoracic pressure.
• Ptp calculated using Pes and ventilator data.

Main Results:

• Mean Ptp was 0.36±1.2 cmH2O.
• Eight patients had negative Ptp.
• Negative Ptp was associated with more eccentric or absent rEBUS signals (75% vs. 45%).

Conclusions:

• Assessing Ptp during RNB is feasible.
• Negative Ptp may indicate a higher likelihood of encountering suboptimal rEBUS signals.
• Further research is needed to understand pulmonary physiology during RNB.