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

• Published in: Current Anesthesiology Reports Vol. 11; no. 4; pp. 446 - 456
• Main Authors: Campos, Javier H., Peacher, Dionne
• Format: Journal Article
• Language: English
• Published: New York Springer US 2021
• Subjects: Anesthesiology; Critical Care Medicine; Intensive; Internal Medicine; Medicine; Medicine & Public Health; Section Editor; Thoracic Anesthesia (AM Bergmann; Thoracic Anesthesia (AM Bergmann, Section Editor); Topical Collection on Thoracic Anesthesia; Video-assisted thoracoscopic surgery (VATS); Robotic-assisted thoracoscopic surgery (RATS); Continuous positive airway pressure (CPAP); Hypoxemia; Lung isolation techniques; One-lung ventilation (OLV)
• ISSN: 1523-3855; 2167-6275; 2167-6275
• DOI: 10.1007/s40140-021-00479-w

Purpose of Review Video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS) are used for anatomic resection of early stage cancer. These surgical techniques require the use of one-lung ventilation (OLV). During OLV, an obligatory intrapulmonary shunt may produce hypoxemia. One method to correct hypoxemia is with the use of continuous positive airway pressure (CPAP). This review focuses on 1) the lung physiology of OLV; 2) application of CPAP in VATS or RATS during supine and lateral position; and 3) the application of CPAP in COVID-19 patients during OLV. Recent Findings Studies have shown the beneficial effects of CPAP to improve oxygenation during OLV while the patient is in the lateral decubitus position. In contrast, studies have shown no benefit on improving oxygenation with CPAP in patients undergoing OLV in supine position. Summary The application of CPAP to the non-dependent lung is one of the options to treat hypoxemia during VATS or RATS.