Safety and Considerations of the Anaesthetic Management during Bronchoscopic Lung Volume Reduction Treatments

BACKGROUND: Different bronchoscopic lung volume reduction approaches are available for a select group of patients with advanced COPD. General anaesthesia is the recommended method of sedation during these procedures. However, this patient population is at an increased risk of anaesthetic complications, and the best approach to general anaesthesia and mechanical ventilation is unknown. OBJECTIVES: The aims of this study were to describe the anaesthetic management techniques used during bronchoscopic lung volume reduction procedures and to investigate the number of anaesthesia-related events. METHODS: Data were retrospectively collected from all endobronchial valve and lung volume reduction coil procedures performed between January 2018 and March 2020 in our hospital. Primary outcomes measures were anaesthetic technique including airway management; ventilation mode and settings; and the incidence of anaesthesia-related events, classified as catastrophic, severe, significant, or moderate. RESULTS: 202 procedures were included. One procedure was performed under procedural sedation, 198 (98%) under general anaesthesia with endotracheal intubation, and 3 (1.5%) under general anaesthesia with laryngeal mask airway. Volume-controlled ventilation was used in 64% of the procedures and pressure-controlled in 36%. Patients were ventilated with a median respiration rate of 9.9 (IQR: 9.6–10.6) breaths per minute, mean tidal volume of 5.8 ± 1.4 mL/kg, and median inspiratory to expiratory (I:E) ratio of 1:2.8 (IQR: 1:2.1–1:3.2). No catastrophic anaesthesia-related events were observed. Hypotension was the most observed anaesthesia-related event. CONCLUSIONS: Despite the presence of advanced COPD, general anaesthesia and mechanical ventilation are well tolerated by patients undergoing endobronchial valve or lung volume reduction coil treatment. This is presumably strongly linked to the strict selection criteria. Other important considerations are using a low respiratory rate, low tidal volume, and high I:E ratio.