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Abstract

Background & objective: Thoracic surgery is almost always performed under general anesthesia (GA) with controlled ventilation through an endotracheal tube (ETT). This study aimed to compare intraoperative ventilation, blood oxygenation parameters between non-intubated video-assisted thoracic surgery (NI-VATS) using a laryngeal mask airway (LMA) with spontaneous/pressure support ventilation (PSV) versus controlled ventilation through ETT with one-lung ventilation (OLV).
Methodology: 100 patients (ASA I-III) undergoing VATS were randomized into two groups of 50 each: NI-VATS group, to receive spontaneous/pressure support ventilation (PSV) through an LMA of a suitable size, and I-VATS group, to receive controlled ventilation through ETT with OLV. Key ventilation parameters and oxygenation parameters were monitored and compared.
Results: I-VATS group had significantly higher tidal volume and minute ventilation. Conversely, NI-VATS group exhibited significantly lower Ppeak during both two-lung (4.06 ± 1.74 cmH2O vs. 24.18 ± 3.94 cmH2O, P < 0.001) and one-lung ventilation (5.36 ± 1.66 cmH2O vs. 30.42 ± 5.46 cmH2O, P < 0.001). NI-VATS group had higher peak EtCO2 (48.56 ± 4.11 mmHg vs. 40.96 ± 4.71 mmHg, P < 0.001) and PaCO2 during OLV (46.84 ± 6.90 mmHg vs. 38.54 ± 7.48 mmHg, P < 0.001). Regarding oxygenation, NI-VATS group required significantly lower highest FiO2 (P < 0.001) yet maintained higher lowest SpO2 (P < 0.001). During OLV, NI-VATS showed higher PaO2 (P < 0.001), a superior PaO2/FiO2 ratio (P < 0.001), and a lower AaDO2 (P < 0.001).
Conclusion: NI-VATS demonstrated advantages in oxygenation efficiency, requiring lower FiO2 while maintaining better SpO2 and gas exchange during OLV, alongside significantly lower airway pressures.
Abbreviations: ETT: endotracheal tube, GA: general anesthesia, LMA: laryngeal mask airway, NI-VATS: non-intubated video-assisted thoracic surgery, OLV: one-lung ventilation, PSV: pressure support ventilation, TCI: Target controlled infusion, VATS: video-assisted thoracic surgery, VILI: ventilator-induced lung injury  
Keywords: ventilation; blood oxygenation; video-assisted; thoracic surgery
Citation: Diep TK, Lu PH, Kinh NQ, Thuy LQ, Hung DD. Comparison of ventilation and blood oxygenation changes in non-intubated versus intubated anesthesia for video-assisted thoracic surgery. Anaesth. pain intensive care 2025;29(7):670-678. DOI: 10.35975/apic.v29i7.2943
Received: June 24, 2025; Revised: August 01, 2025; Accepted: August 01, 2025