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

## TL;DR

This case report shows how a new tool called IPI helps monitor breathing during a specific type of chest surgery without a breathing tube.

## Contribution

The study demonstrates the practical use of the Integrated Pulmonary Index (IPI) for real-time respiratory monitoring during tubeless VATS.

## Key findings

- IPI tracking maintained respiratory stability with a target range of 8–10.
- IPI ≤ 4 triggered immediate assisted ventilation, preventing respiratory compromise.
- Postoperative blood gases confirmed effective ventilation management.

## Abstract

“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 [EtCO2, respiratory rate (RR), heart rate (HR), and SpO2] into a single score ranging from 1 to 10.

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, EtCO2 35–45 mmHg) while promptly identifying deterioration. Postoperative arterial blood gases (PaCO2 42 mmHg, pH 7.33) validated optimal ventilation management.

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.