CHEST Guidelines-Ventilatory-Strategy-to-Prevent-Atelectasis-During

Ventilatory-Strategy-to-Prevent-Atelectasis-During

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A recent article by Salahuddin et al. in the journal CHEST studied a ventilatory strategy to prevent atelectasis during bronchoscopy under general anesthesia. The strategy, called VESPA, involves endotracheal intubation followed by a recruitment maneuver, significantly reducing the occurrence of atelectasis. The authors conclude that VESPA is well-tolerated and capable of maintaining its effects over time.<br /><br />In response to this article, Diamanto Aretha, MD, PhD, and colleagues from the University Hospital of Patras have highlighted the role of the laryngeal mask airway (LMA), which was used as a comparison in the study's control group. LMA is commonly employed in short-term surgeries or procedures due to its less invasive nature and its benefits, such as improved hemodynamic stability and a reduced need for anesthetics and muscle relaxants. The authors noted that second-generation LMAs, which have low airway leakage, are suitable for positive pressure ventilation with moderate or low tidal volumes. They argue that using low tidal volumes with LMA can increase alveolar collapse and lead to hypoxemia, suggesting that employing positive end-expiratory pressure (PEEP) with second-generation LMAs may mitigate this effect by reducing atelectasis and improving oxygenation.<br /><br />The editors invited Salahuddin et al. to respond to these comments. In their response, they acknowledged the points raised by Aretha and colleagues, noting that their standard practice does involve the use of second-generation LMAs for endobronchial ultrasound scanning, as it aligns with the discussed ventilatory approaches. The exchange highlights ongoing discussions in the medical field regarding optimizing ventilatory strategies to prevent atelectasis during procedures under general anesthesia.

Keywords

VESPA

atelectasis

bronchoscopy

general anesthesia

laryngeal mask airway

positive pressure ventilation

recruitment maneuver

positive end-expiratory pressure

oxygenation

ventilatory strategies