Severity of Atelectasis during Bronchoscopy: Descriptions of a New Grading System (Atelectasis Severity Scoring System—“ASSESS”) and At-Risk-Lung Zones

Author:

Khan Asad1ORCID,Bashour Sami1ORCID,Sabath Bruce1,Lin Julie1,Sarkiss Mona2,Song Juhee3ORCID,Sagar Ala-Eddin S.4,Shah Archan5,Casal Roberto F.1

Affiliation:

1. Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA

2. Department of Anesthesia and Peri-Operative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA

3. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA

4. Department of Internal Medicine, King Faisal Specialist Hospital and Research Center, Madinah 42523, Saudi Arabia

5. Department of Onco-Medicine, Banner MD Anderson Cancer Center, Gilbert, AZ 85234, USA

Abstract

Atelectasis during bronchoscopy under general anesthesia is very common and can have a detrimental effect on navigational and diagnostic outcomes. While the intraprocedural incidence and anatomic location have been previously described, the severity of atelectasis has not. We reviewed chest CT images of patients who developed atelectasis in the VESPA trial (Ventilatory Strategy to Prevent Atelectasis). By drawing boundaries at the posterior chest wall (A), the anterior aspect of the vertebral body (C), and mid-way between these two lines (B), we delineated at-risk lung zones 1, 2, and 3 (from posterior to anterior). An Atelectasis Severity Score System (“ASSESS”) was created, classifying atelectasis as “mild” (zone 1), “moderate” (zones 1–2), and “severe” (zones 1–2–3). A total of 43 patients who developed atelectasis were included in this study. A total of 32 patients were in the control arm, and 11 were in the VESPA arm; 20 patients (47%) had mild atelectasis, 20 (47%) had moderate atelectasis, and 3 (6%) had severe atelectasis. A higher BMI was associated with increased odds (1.5 per 1 unit change; 95% CI, 1.10–2.04) (p = 0.0098), and VESPA was associated with decreased odds (0.05; 95% CI, 0.01–0.47) (p = 0.0080) of developing moderate to severe atelectasis. ASSESS is a simple method used to categorize intra-bronchoscopy atelectasis, which allows for a qualitative description of this phenomenon to be developed. In the VESPA trial, a higher BMI was not only associated with increased incidence but also increased severity of atelectasis, while VESPA had the opposite effect. Preventive strategies should be strongly considered in patients with risk factors for atelectasis who have lesions located in zones 1 and 2, but not in zone 3.

Funder

Cancer Center Support Grant

Publisher

MDPI AG

Subject

Clinical Biochemistry

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