Spontaneous versus mechanical ventilation during video-assisted thoracoscopic surgery for spontaneous pneumothorax: A randomized trial.

Abstract

OBJECTIVE\nSpontaneous ventilation video-assisted thoracic surgery (SV-VATS) is reported to have superior or equal efficacy on postoperative recovery to mechanical ventilation VATS (MV-VATS). However, perioperative safety of the SV-VATS blebectomy is not entirely demonstrated.\n\n\nMETHODS\nWe performed a noninferiority, randomized controlled trial (No. NCT03016858) for primary spontaneous pneumothorax patients aged 16 to 50\xa0years undergoing a SV-VATS and the MV-VATS procedure. The trial was conducted at 10 centers in China from April 2017 to January 2019. The primary outcome was the comparison of intra- and postoperative complications between SV-VATS and MV-VATS procedures. Secondary outcomes included total analgesia dose, change of vital sign during surgery, procedural duration, recovery time, postoperative visual analog pain scores, and hospitalization length.\n\n\nRESULTS\nIn this study, 335 patients were included. There was no significant difference between the SV-VATS group and the MV-VATS group in the intra- and postoperative complication rates (17.90% vs 22.09%; relative risk, 0.81; 95% confidence interval, 0.52-1.26; P\xa0=\xa0.346). The SV-VATS group was associated with significantly decreased total dose of intraoperative opioid agents; that is, sufentanil (11.37\xa0μg vs 20.92\xa0μg; P\xa0<\xa0.001) and remifentanil (269.78\xa0μg vs 404.96\xa0μg; P\xa0<\xa0.001). The SV-VATS procedure was also associated with shorter extubation time (12.28\xa0minutes vs 17.30\xa0minutes; P\xa0<\xa0.001), postanesthesia care unit recovery time (25.43\xa0minutes vs 30.67\xa0minutes; P\xa0=\xa0.02) and food intake time (346.07\xa0minute vs 404.02\xa0minutes; P\xa0=\xa0.002). Moreover, the SV-VATS procedure deceased the anesthesia cost compared with the MV-VATS ($297.81 vs $399.81; P\xa0<\xa0.001).\n\n\nCONCLUSIONS\nSV-VATS was shown to be noninferior to MV-VATS in term of complication rate and in selected patients undergoing blebectomy for primary spontaneous pneumothorax.