Collateral ventilation measurement using Chartis: procedural sedation versus general anesthesia.

Welling, Jorrit B A; Klooster, Karin; Hartman, Jorine E; Kerstjens, Huib A M; Franz, Ina; Struys, Michel M R F; Absalom, Anthony R; Slebos, Dirk-Jan; Barends, Clemens R M

BACKGROUND Absence of interlobar collateral ventilation is key to successful endobronchial valve treatment in patients with severe emphysema and can be functionally assessed using the Chartis® measurement. Chartis has been validated during spontaneous breathing, undergoing procedural sedation (PS), but can also be performed under general anesthesia (GA). Performing Chartis under PS is often challenging because of coughing, mucus secretion and difficulties in maintaining an adequate level of sedation. The study objective was to investigate whether there is a difference in Chartis measurement outcomes between PS and GA. METHODS In this prospective study patients underwent Chartis measurements under both PS and GA. Study outcomes were Chartis measurement duration, number of measurements, feasibility and success rate. RESULTS We included 30 patients with severe emphysema (mean age 62 years and median FEV1 29% of pred.). Chartis measurement duration was significantly longer under PS than under GA (mean 20.3±4.2 minutes versus 15.1±4.4, P<0.001). There was no difference in the number of measurements performed (median 2 (range 1-3) for PS versus 1 (1-3) for GA, P=1.00). Chartis measurement was more feasible during GA (median sum of all feasibility scores: 12 (range 6-26) for PS versus 7 (5-13) for GA, P<0.001), with no statistical difference in success rate: 77% of cases for PS versus 97% under GA, P=0.07. CONCLUSION This study shows that Chartis measurement under general anesthesia is faster and more feasible to perform compared to procedural sedation, without affecting measurement outcomes.