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

Inclusion Criteria13

• 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 \< 45 days prior to bronchoscopy.
• Voluntary informed consent to participate in the study.
• 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.