Awake videothoracoscopic biopsy of diffuse lung disease. Effects on pulmonary function and oxygenation

Surgical biopsy of diffuse lung disease (DLD) performed through general anesthesia has been associated with relatively high rate of pulmonary complications. Having hypothesized that videothoracoscopic biopsy of DLD could be feasible in awake patients, we have investigated its effects on pulmonary function and oxygenation. Twenty-one patients with DLD were enrolled in a pilot investigation entailing videothoracoscopic biopsy performed in awake patients through sole epidural anesthesia . Spirometry was performed preoperatively in sitting position (T0) and in lateral decubitus position either immediately before the operation (T1) and intraoperatively, after creation of the surgical pneumothorax (T2). Main cardiorespiratory data including mean arterial pressure (MAP), heart rate (HR), the ratio of arterial oxygen tension to fraction of inspired oxygen (PaO2/FiO2) and carbon dioxide tension (PaCO2) were assessed at T1, T2, at the end of the operation (T3) and 1h after the operation (T4). Mean age was 58±11 years. At T0, FEV1, FVC and TLC were 2,2L (78%), 2,8L (75%) and 4,4L (74%), respectively. At T1, FEV1 and FVC decreased by 10±12% and 14±13%, respectively while at T2, by 48±5% and 45±6%, respectively. MAP and HR remained relatively stable throughout the procedure. PaO2/FiO2 decreased from 321±49 at T1 to 235±72 at T3 (P=0.0006) but improved up to 284±49 at T4. All patients tolerated satisfactorily the procedure. Histologic diagnosis was always obtained. There was no morbidity and mean hospital stay was 1.5±0.6 days. In our study cohort, changes in pulmonary function and oxygenation measures occurring during awake videothoracoscopic lung biopsy were satisfactorily tolerated by the patients and did not jeopardize its feasibility.