A Randomized Trial Comparing a Ventilatory Strategy To Prevent Atelectasis Versus a Lateral Decubitus Strategy During Robotic Bronchoscopy (VESPA vs. LADS Trial)

Study Overview
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Brief Summary
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To learn if LADS is better than VESPA at preventing atelectasis during a robotic bronchoscopy.

Detailed Description
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Primary Objective: To compare the proportion of patients developing target-obscuring atelectasis when using a lateral decubitus strategy (LADS) vs using a ventilatory strategy to prevent atelectasis (VESPA) during robotic bronchoscopy for posteriorly-located peripheral lung lesions. Secondary Objectives: To compare the proportion of patients with atelectasis in the target lobe in VESPA vs. LADS during robotic bronchoscopy. To compare the proportion of patients with atelectasis obscuring 100%, 50% or more, and less than 50% of the target during robotic bronchoscopy using LADS vs. VESPA. To compare the proportion of patients in whom a biopsy sample was not taken due to atelectasis using LADS vs. VESPA. To compare the diagnostic yield using LADS vs. VESPA. To compare the proportion of tool in lesion (TIL) using LADS vs. VESPA. To compare the diagnostic accuracy (sensitivity and specificity) for malignancy using LADS vs. VESPA. To compare the proportion of LADS-induced vs. VESPA-induced complications. To compare the proportion of bronchoscopy-induced complications in LADS vs. VESPA.

Official Title
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A Randomized Trial Comparing a Ventilatory Strategy To Prevent Atelectasis Versus a Lateral Decubitus Strategy During Robotic Bronchoscopy (VESPA vs. LADS Trial)

Conditions
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Pulmonary, Lung

Intervention / Treatment
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* Procedure: Ventilatory Strategy To Prevent Atelectasis
* Procedure: Lateral Decubitus Strategy (LADS)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult patients (≥ 18 years old) undergoing diagnostic robotic bronchoscopy for a lung nodule suspicious for malignancy bronchoscopy under general anesthesia. Lung nodules should be up to 3 cm in diameter and located in right or left bronchial segments B2, B6, B9, and B10. Greater than 50% of the volume of the lesion needs to be below a horizontal line traced at the most anterior edge of the corresponding vertebral body. Chest CT performed < 4 weeks prior to bronchoscopy. Voluntary informed consent to participate in the study. Exclusion Criteria: Patients with prior lung consolidation, interstitial changes or lung masses (> 3 cm in diameter) as seen on most recent CT Lesions outside of the designated lung areas defined as inclusion criteria. Known pregnancy Vulnerable population Ascites Known diaphragmatic paralysis Smokers or ex-smokers with known or suspected severe air-trapping defined as residual volume > 150% of predicted History of primary or secondary spontaneous pneumothorax Lung bullae > 5 cm Patients with mediastinal or hilar adenopathy with high suspicion for malignancy in whom lymph node sampling is indicated and should occur prior to robotic bronchoscopy of the peripheral lesion. Patient with active COVID pneumonia.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Allocation: Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Group 1<br>Group 1, Participants will receive VESAP during the bronchoscopy. Ventilatory Strategy To Prevent Atelectasis versus a Lateral Decubitus Strategy During Robotic Bronchoscopy | Procedure: Ventilatory Strategy To Prevent Atelectasis<br>* Given<br>|
| Experimental: Group 2<br>Group 2, Participants will receive LADS Lateral Decubitus Strategy During Robotic Bronchoscopy during the bronchoscopy. | Procedure: Lateral Decubitus Strategy (LADS)<br>* Given<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Incidence of Adverse Events, Graded According to National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) Version (v) 5.0 |  | through study completion; an average of 1 year. |