B80-4-16 Stop the Wind to Hit the Mark: Prolonged Breath Hold in Robotic-Guided Lung Biopsy

Abstract Rationale Robotic-assisted bronchoscopy (RAB) enables precise biopsy of peripheral pulmonary lesions, particularly when integrated with cone-beam CT imaging. Ventilation parameters—including tidal volume, positive end-expiratory pressure (PEEP), and apneic breath-holds—affect airway caliber, lesion stability, and lesion-tool alignment. Breath-holding maneuvers are widely used to stabilize targets, yet the optimal duration, feasibility, and safety of prolonged apnea have not been systematically evaluated. Objectives To describe physiologic and clinical outcomes associated with prolonged apneic breath-holds during robotic bronchoscopy, using apnea duration as the primary exposure variable. Methods We performed a retrospective single-center analysis of all robotic bronchoscopy cases between December 2023 and September 2025. Procedures including ≥15-minute apneic breath-holds were identified using validated EHR-based algorithms developed with the UCDH Data Center of Excellence. For each case, apnea duration, pre- and post-breath-hold end-tidal carbon dioxide (ETCO2), procedural outcomes, and complications were recorded. Continuous variables were summarized as mean, median, and range. Results Patients were pre-oxygenated with 100% FiO2, and breath-holds were performed during inspiration with PEEP/APL set to 15-20 mm Hg. Cone-beam CT acquisition and biopsy occurred during the breath-hold. Across 137 unique cases, 154 apneic events ≥15 minutes were recorded (mean 1.12 per case). Duration: 15-42 min (median 19 min). Carbon dioxide: peak post-hold ETCO2 106.4 mm Hg; mean 63.3; median 60.3 mm Hg. Oxygenation: saturations generally 95% throughout. Diagnostic outcomes (n = 137): 83 (60.6%) malignant, 17 (12.4%) benign, 34 (24.8%) indeterminate, 3 (2.2%) no result. Intermittent vasopressor support occurred in a subset, likely due to elevated PEEP and reduced preload. No cardiac arrest, respiratory failure, or ICU admission was attributable to apnea. Six patients experienced post-procedural complications: three pneumothoraces, one hemoptysis, one transient hypoxia resolving after thoracentesis, and one altered mental status unrelated to hypercarbia. Conclusions Prolonged apneic breath-holds ≥15 minutes—up to 42 minutes—were feasible and generally well-tolerated, despite significant ETCO2 elevations. This represents the first systematic characterization of extended apnea during robotic lung biopsy. Continued analysis will explore correlations between apnea duration, hypercarbia, desaturation, arrhythmia, and vasopressor use. These findings support the physiologic safety of prolonged breath-hold strategies and may guide evidence-based anesthesia protocols and patient selection for robotic bronchoscopy. This abstract is funded by: None