Awake or intubated surgery in diagnosis for interstitial lung diseases? A prospective study

Background Risks associated with Video-Assisted Surgical Lung Biopsy (VASLB) for interstitial lung disease (ILD) with endotracheal intubation and mechanical ventilation are not nil. Awake Video-Assisted Surgical Lung Biopsy (Awake-VASLB) has been proposed as a method to obtain a precise diagnosis in several different thoracic diseases. Objectives To compare clinical outcomes of Awake-VASLB and Intubated-VASLB in patients with suspected ILDs. Methods From June 2016 to February 2020, all patients submitted to elective VASLB for suspected ILD were included. Differences in outcomes between Awake-VASLB and Intubated-VASLB were assessed through univariable, multivariable-adjusted, and a propensity score-matched (PS) analysis. Measurements and main results Awake-VASLB was performed in 66 out of 100 patients, while 34 underwent Intubated-VASLB. The Awake- VASLB resulted in a lower postoperative morbidity (OR 0.025; CI95% 0.001, 0.35; p=0.006), a less unexpected Intensive Care Unit (ICU) admission, a less need for rescue therapy for pain, a reduced surgical and anaesthesiologic time, a reduced chest drain duration, a lower postoperative length of stay. Conclusion Awake-VASLB in patients affected by ILD is feasible and seems safer than Intubated-VASLB.