Effect of non-intubated anaesthesia video-assisted thoracoscopic surgery on postoperative diaphragm function and pulmonary complications in patients undergoing lung surgery: a randomized clinical trial

Background: Postoperative diaphragmatic dysfunction (PDD) and pulmonary complications (PPCs) are common complications in patients undergoing video-assisted thoracoscopic (VATS) lung surgery. There is increasing evidence for the safety and advantages of non-intubated anaesthesia in VATS lung surgery. It remains, however, to be demonstrated whether non-intubated anaesthesia in these patients improved PDD and PPCs. Methods and methods: Between 9 October 2022 and 26 November 2023, 160 patients scheduled for VATS lung surgery were enrolled and randomly allocated to non-intubated anaesthesia (NIVATS) group or intubated anaesthesia (IVATS) group. The primary outcome was the incidence of PDD at 24 hours postoperatively defined as a diaphragmatic excursion less than 10 mm evaluated by ultrasound. The occurrence of PPCs was assessed up to 7 days after surgery. Results: The incidence of PDD at 24 h was significantly lower in the NIVATS group (28 of 80, [35.0%]) than IVATS group (46 of 80 [57.5%]; relative risk [95% confidence interval], 0.61 [0.43-0.87]; P <0.001). The rate of PPCs was significantly lower in the NIVATS group (14 of 80, [17.5%]) than IVATS group (27 of 80 [33.8%]; relative risk [95% confidence interval], 0.52 [0.29-0.91]; P = 0.019). Conclusions: Non-intubated anaesthesia reduced the incidence of PDD and PPCs for patients undergoing VATS lung surgery. These findings indicated that NIVATS offers more benefits and may be a superior option compared to IVATS for selected patients.