Impact of Ventilator Settings on Pulmonary Nodule Localization Accuracy in a Hybrid Operating Room: A Single-Center Study

<b>Background:</b> Pulmonary nodule localization in a hybrid operating room (OR) followed by thoracoscopic operation presents a viable alternative for early lung cancer treatment, potentially supplanting conventional two-stage preoperative computed tomography-guided localization. This hybrid OR technique enables lesion localization under positive ventilation, contrasting with the traditional method requiring concurrent respiratory motion. This study aimed to evaluate our experience with different ventilator settings and the accuracy of pulmonary nodule localization. <b>Methods:</b> We retrospectively analyzed 176 patients with multiple pulmonary nodules who had localization procedures in our hybrid operating room. Ninety-five patients were assigned to the traditional ventilator setting group (tidal volume 8-10 mL/kg) and 81 to the lung-protective strategy group (tidal volume < 8 mL/kg). Localization accuracy was assessed via hybrid computed tomography imaging, ensuring that the needle-to-lesion distance was ≤5 mm. Between-group differences were assessed using the chi-squared test, Fisher's exact test, and the Mann-Whitney U test, as appropriate. <b>Results:</b> Pathological findings revealed primary lung malignancy in 150 patients, inclusive of invasive adenocarcinoma, adenocarcinoma in situ, and minimally invasive adenocarcinoma. Multivariate regression analysis identified tidal volume, nodule count, and localization depth as significant predictors of localization accuracy. <b>Conclusions:</b> This study demonstrated that ventilator settings with a tidal volume of 8-10 mL/kg significantly enhanced localization accuracy and slightly improved patient oxygenation. However, additional randomized controlled trials are warranted to validate these findings and establish definitive guidelines for future interventions.