Integrated pulmonary index (IPI)-guided ventilation management during “tubeless” video-assisted thoracoscopic surgery under general anesthesia: a case report

Background “Tubeless” anesthesia for video-assisted thoracoscopic surgery (VATS) maintains spontaneous ventilation but complicates respiratory monitoring. The integrated pulmonary index (IPI) is a non-invasive tool that assesses respiratory status by integrating four real-time parameters [EtCO 2 , respiratory rate (RR), heart rate (HR), and SpO 2 ] into a single score ranging from 1 to 10. Case presentation We present a 42-years-old female who underwent right middle lobectomy under tubeless anesthesia with continuous IPI monitoring. Anesthesia was maintained via laryngeal mask airway with spontaneous ventilation, supplemented by total intravenous anesthesia and paravertebral blockade. The IPI system facilitated tiered respiratory management: IPI ≤ 6 signaled acute respiratory events, while IPI ≤ 4 necessitated immediate assisted ventilation intervention. Real-time IPI tracking ensured respiratory stability (target range 8–10, EtCO 2 35–45 mmHg) while promptly identifying deterioration. Postoperative arterial blood gases (PaCO 2 42 mmHg, pH 7.33) validated optimal ventilation management. Conclusion This case demonstrates IPI’s efficacy in detecting early ventilatory compromise during tubeless VATS, enabling proactive intervention without compromising surgical advantages. Further refinement of IPI thresholds may enhance perioperative safety in spontaneous ventilation anesthesia.