Restore Airway Patency Research Articles

LARINGOESPASMO EM CRIANÇAS DURANTE PROCEDIMENTOS SOB ANESTESIA

Introduction: Laryngospasm can result in partial or complete loss of the patient’s airway. It is an anesthetic emergency caused by an exacerbated reflex that can occur with the closure of the vocal cords, accompanied by the descent of the epiglottis over the laryngeal orifice, and which is still responsible for significant morbidity and mortality in pediatric patients. It is most common in children under two years of age. The management of laryngospasm consists of its prevention, recognition, treatment and post-anesthetic care. Objective: To identify recent approaches to laryngospasm in children during anesthetic procedures in the literature. Methodology: This is a literature review, highlighting laryngospasm in children undergoing anesthetic procedures. Final considerations: Laryngospasm in children during anesthesia is a critical situation. Effective management is important with rapid and appropriate interventions to restore airway patency and ensure adequate oxygenation of the child, avoiding complications. The anesthesiologist must pay attention to the risk factors involved, and an in-depth understanding of these aspects is crucial for doctors, who, together with the surgical team, can guarantee the safety and well-being of pediatric patients during anesthetic procedures.

Safety assessment of using macintosh laryngoscope, airtraq, I-view, UESCOPE by non-clinically experienced individuals on a manikin model: A randomized cross-over study

BackgroundEndotracheal intubation is the best way of restoring airway patency. Covid-19 epidemic showed that the health professionals without previous experience may be forced to use this technique in the state of necessity, exposing the patients to both local and systemic complications. In our study we wanted to specify which of the four laryngoscopes is safer for a patient when used by this group of medical staff. MethodsThe study involved 55 4th year students of Faculty of Medicine and Dentistry who had never previously practiced using videolaryngoscopes and had minimal experience with the Macintosh laryngoscope. ResultsDental injury rates: Macintosh (n = 18, 33 %), I-View (n = 13, 24 %), UESCOPE (n = 10, 18 %), and Airtraq (n = 7, 13 %), though differences were not statistically significant (p = 0.071). Notable variations were observed in maximum pressure: I-View (88.9 mmHg, IQR: 72.75–106.5), Macintosh (87.1 mmHg, IQR: 75.1–110.35), UESCOPE (72.7 mmHg, IQR: 61–86), and Airtraq (54.7 mmHg, IQR: 41.8–67.25). The difference between Macintosh and I-View was not significant. Pressure during intubation showed a similar trend: Macintosh (48.3 mmHg, IQR: 42.85–59.4), I-View (45.2 mmHg, IQR: 35.7–54.85), UESCOPE (33 mmHg, IQR: 27.95–41.5), Airtraq (21.6 mmHg, IQR: 18.4–24.9). Airtraq usage correlated with shorter intubation times (9.9 s, IQR: 8.4–12.25) compared to Macintosh (27 s, IQR: 23.8–32.05), I-View (24.5 s, IQR: 19.25–31.35), and UESCOPE (23.6 s, IQR: 17–29.5). Airtraq was the best-rated device by respondents. Airway visualization was superior with Airtraq, as assessed by Cormack-Lehane and POGO scales. On the Cormack-Lehane scale, Airtraq scored 2 (IQR: 2-2), versus Macintosh (3, IQR: 3-3), I-View (2, IQR: 2–3), and UESCOPE (2, IQR: 2–3). On the POGO scale, Airtraq scored 70 % (IQR: 60%–90 %), compared to Macintosh (30 %, IQR: 20%–30 %), I-View (60 %, IQR: 30%–60 %), and UESCOPE (50 %, IQR: 30%–70 %) ConclusionsAirtraq laryngoscope on a mannequin model turned out to be device that damages the teeth the least, exerts the lowest pressure on the tongue and giving the possibility of the fastest intubation with the greatest comfort for the operator in the studied group of users.

How should respiratory depression and loss of airway patency be handled during initiation of palliative sedation?

Loss of airway patency has been reported during initiation of palliative sedation. In present guidelines the loss of airway patency during initiation of palliative sedation is not addressed. Airway patency can be restored by jaw thrust/chin lift or placing the patient in the recovery position. A structured ethical analysis of how respiratory depression and loss of airway patency during initiation of palliative sedation should be handled. The essence of the dilemma is whether it is appropriate to apply simple non-invasive methods to restore airway patency in order to avoid the patient's immediate death. A structured analysis based on the four principles of healthcare ethics and stakeholders' interests. Beneficence and autonomy support a decision not to regain airway patency whereas non-maleficence lends weight to a decision to restore airway patency. Whether the proportionality criterion of the principle of double effect is met depends on the features of the individual case. The ethical problem appears to be a genuine dilemma where important values and arguments point to different conclusions. Whether to restore airway patency when the airway is obstructed during initiation of palliative sedation will ultimately be based on clinical judgment taking into account both any known patient preferences and relevant clinical information. There are strong arguments favoring both options in this clinical and ethical dilemma. The fact that a clear and universal recommendation cannot be made does not imply indifference regarding what is the clinically and ethically best option for each individual patient.

Fabrication of a 3D printed everolimus-eluting stent made of thermoplastic polyurethane and polylactide

Bronchial stenoses are one of the most common airways complications after lung transplantation. One of the main methods to restore airway patency is bronchial stenting. However, bronchial stenting is associated with a number of complications, such as stent migration, granulation tissue formation along the proximal and distal edges, and mucus obstruction of the lumen. This article demonstrates the possibility of manufacturing an everolimus-eluting stent from thermoplastic polyurethane and polylactide using 3D printing.

Thulium fiber laser use in interventional bronchoscopy in lung recipients

Bronchial stenosis is a major cause of severe postoperative period in lung recipients. One of the methods to restore airway patency is recanalization using laser. This technique is popular due to the combination of cutting and coagulation effects. In this article, we demonstrate the possibility of intraluminal use of a thulium fiber laser (TFL) to recanalize bronchial stenosis in lung recipients.

Cryoextraction via flexible bronchoscopy in children with tracheobronchial obstruction.

Cryoextraction via flexible bronchoscopy (FB) can be used to alleviate airway obstruction due to blood clots, casts, mucus, and foreign bodies. There is limited literature regarding the utility of cryoextraction to restore airway patency in critically ill children, especially on extracorporeal membrane oxygenation (ECMO). The aims of this study were to describe the clinical course and outcomes of children who underwent cryoextraction via FB. A singlecenter retrospective review of children who underwent cryoextraction via FB between 2017 and 2021 was conducted. The analyzed data included diagnoses, indications for cryoextraction, respiratory support modalities, FB and chest imaging results, and outcomes. Eleven patients aged 3-17 years underwent a total of 33 cryoextraction sessions via FB. Patients required ECMO (n = 9) or conventional mechanical ventilation (CMV) for pneumonia, pulmonary hemorrhage, pulmonary embolism, asthma exacerbation, and cardiorespiratory failure following cardiac surgery. One patient underwent elective FB and cryoextraction for plastic bronchitis. Indications for cryoextraction included airway obstruction due to tracheobronchial thrombi (n = 8), mucus plugs (n = 1), or plastic bronchitis (n = 2). Cryoextraction via FB was performed on patients on ECMO (n = 9) and CMV (n = 2) with 6 patients requiring ≥3 cryoextraction sessions for airway obstruction. There were no complications related to cryoextraction. Patient outcomes included partial (n = 5) or complete (n = 6) restoration of airway patency with ECMO decannulation (n = 5) and death (n = 4) due to critical illness. Cryoextraction via FB is an effective intervention that can be utilized in critically ill children with refractory tracheobronchial obstruction to restore airway patency and to facilitate liberation from ECMO.

Airway Stent in Lung Cancer: A Narrative Literature Review

Lung cancer complications are the leading cause of death in lung cancer patients. This study aimed to describe the prevalence of stent placement, indications for stent placement, success and complication rates, and prognosis of airway stent placement in patients with lung cancer. Malignant central airway obstruction (MCAO) is one of the significant complications. Insertion of airway stent can restore airway patency in more than 90% of patients with MCAO. Airway stent placement is indicated in patients with extrinsic lesions, obstruction of ≥ 50%, have patent airway below the obstruction, and are not in the terminal state. The technical success was reported to be very high and consistent with the range of 95-100%. Early complications were relatively rare; however, up to 87% of long-term complications were reported. Stent placement is a risk factor for lower respiratory tract infection, an adverse prognostic factor in lung cancer survival. Airway stents should be indicated and used with caution and discretion. With the advancement and development of technology, various materials and types of airway stents are being developed to minimize adverse outcomes.

Cryotherapy in the paediatric airway: Indications, success and safety.

Cryotherapy in interventional bronchoscopy is a new treatment modality, which has recently been made available for the paediatric airway. Lack of experience and safety concerns have led to hesitant adaptation. The aim of this study was to assess indications, success rates and complications of airway cryotherapy in children. Bronchoscopists from medical centre performing cryotherapy in patients between 0 and 18 years were invited to participate in a prospective study based on an online questionnaire. Patient and participant data were collected between June 2020 and June 2021. A total of 69 cryotherapy procedures were performed in 57 patients a for three main indications: Biopsy (30), restoration of airway patency (23) and foreign body aspiration (16). The overall success rate was 93%, the remaining 7% were performed for foreign body removal and required a switch of technique. Restoration of airway patency was successfully applied in various pathologies, including mucus plugs, bronchial casts and post traumatic stenosis. The diagnostic yield of transbronchial biopsies was 96%. No severe complications were encountered; one pneumothorax following a cryobiopsy required a chest drain for 48 h. No child was admitted to intensive care or died from a procedural complication. In this largest paediatric case collection to date, cryotherapy was safe and carried a high success rate. Cryobiopsy compares favourably to the widely used forceps biopsy and could replace it in the future. Paediatric bronchoscopists are encouraged to add cryotherapy to their armamentarium of airway interventions.

Clinical grade manufacture of 3D printed patient specific biodegradable devices for pediatric airway support

Implantable patient-specific devices are the next frontier of personalized medicine, positioned to improve the quality of care across multiple clinical disciplines. Translation of patient-specific devices requires time- and cost-effective processes to design, verify and validate in adherence to FDA guidance for medical device manufacture. In this study, we present a generalized strategy for selective laser sintering (SLS) of patient-specific medical devices following the prescribed guidance for additive manufacturing of medical devices issued by the FDA in 2018. We contextualize this process for manufacturing an Airway Support Device, a life-saving tracheal and bronchial implant restoring airway patency for pediatric patients diagnosed with tracheobronchomalacia and exhibiting partial or complete airway collapse. The process covers image-based modeling, design inputs, design verification, material inputs and verification, device verification, and device validation, including clinical results. We demonstrate how design and material assessment lead to verified Airway Support Devices that achieve desired airway patency and reduction in required Positive End-Expiratory Pressure (PEEP) after patient implantation. We propose this process as a template for general quality control of patient-specific, 3D printed implants.

Tactical Combat Casualty Care: Guidelines for Medical Personnel (TCCC-MP, 2021)

The TCCC (Tactical Combat Casualty Care) standards are developed by the TCCC Committee, which is a part of the Joint Trauma System of the US Ministry of Defense. The latest version of the guidelines for medical personnel was translated into Ukrainian by the specialists of the Association of Anesthesiologists of Ukraine (https:// aaukr.org/rekomendatsiyi-z-taktychnoyi-dopomogy-poranenym-v-umovah-bojovyh-dij-dlya-medychnogo-personalu). The latest version includes updates on the devices for stopping junctional hemorrhages and restoring airway patency, recommendations for analgesia and for penetrating abdominal injuries with intestine evisceration.

A narrative review of progress in airway stents.

Background and ObjectiveAirway stents, used to restore airway patency, are mostly utilized by patients with malignant airway strictures, and are occasionally used in a range of other airway related diseases, including conditions which result in benign stenosis, malacia, and fistula. There has been an increasing number of airway stents that are being developed thanks to improvements in interventional therapy. However, the method of promoting airway stents for clinical application remains undetermined. Herein, we describe the recent advances in airway stents by reviewing the published studies, providing the reference for clinical decision-making and further research on airway stents.MethodsRelevant articles between January 1964 and November 2021 were obtained from PubMed, Web of Science, and EMBASE databases. The terms “metallic”, “silicone”, “drug-eluting", “biodegradable”, “radioactive”, “three-dimensional (3D)”, and “stents” were searched in different combinations.Key Content and FindingsIn this review, we focus on the latest evidence in terms of the application of various stents with novel materials and designs including novel metallic, novel silicone, drug-eluting, biodegradable, radioactive, and 3D stents for airway stenosis. Despite reducing the well-known complications of all current commercially available stents, novel stents are still in their infancy without a long track record of utility and safety, and remain some limitations. There are more steps to be taken before such stents enter routine clinical practice.ConclusionsA combination of 3D-printing method and biodegradable material may present a promising avenue of solving the existing problems pertaining to “classic” stents and has potential to become the main trend in the future.

Molecular Mechanisms and Physiological Changes behind Benign Tracheal and Subglottic Stenosis in Adults.

Laryngotracheal stenosis (LTS) is a complex and heterogeneous disease whose pathogenesis remains unclear. LTS is considered to be the result of aberrant wound-healing process that leads to fibrotic scarring, originating from different aetiology. Although iatrogenic aetiology is the main cause of subglottic or tracheal stenosis, also autoimmune and infectious diseases may be involved in causing LTS. Furthermore, fibrotic obstruction in the anatomic region under the glottis can also be diagnosed without apparent aetiology after a comprehensive workup; in this case, the pathological process is called idiopathic subglottic stenosis (iSGS). So far, the laryngotracheal scar resulting from airway injury due to different diseases was considered as inert tissue requiring surgical removal to restore airway patency. However, this assumption has recently been revised by regarding the tracheal scarring process as a fibroinflammatory event due to immunological alteration, similar to other fibrotic diseases. Recent acquisitions suggest that different factors, such as growth factors, cytokines, altered fibroblast function and genetic susceptibility, can all interact in a complex way leading to aberrant and fibrotic wound healing after an insult that acts as a trigger. However, also physiological derangement due to LTS could play a role in promoting dysregulated response to laryngo-tracheal mucosal injury, through biomechanical stress and mechanotransduction activation. The aim of this narrative review is to present the state-of-the-art knowledge regarding molecular mechanisms, as well as mechanical and physio-pathological features behind LTS.

Treatment of post-intensive care tracheal stenosis after previous covid-19 pneumonia

To analyze postoperative outcomes and perioperative management of patients with post-intensive care tracheal stenosis and previous COVID-19 pneumonia. There were 8 patients with post-intensive care tracheal stenosis and previous COVID-19 pneumonia aged 34-61 years between January 2021 and April 2021. Lung damage CT-3 was observed in 2 (25%) patients, CT-4 - in 5 (62.5%) patients. In one case, COVID-19 pneumonia with lung damage CT-2 joined to acute cerebrovascular accident. Post-tracheostomy stenosis was detected in 7 (87.5%) cases, post-intubation stenosis - in 1 patient. Duration of invasive mechanical ventilation ranged from 5 to 130 days. In 75% of cases, tracheal stenosis was localized in the larynx and cervical trachea. Two patients admitted with tracheostomy. In one case, an extended tracheal stenosis was combined with atresia of infraglottic part of the larynx. One patient had tracheal stenosis combined with tracheoesophageal fistula (TEF). Length of tracheal stenosis was 15-45 mm. Tracheomalacia was observed in 4 (50%) patients. All patients had severe concomitant diseases. To restore airway patency, we used circular tracheal resection with anastomosis, laryngotracheoplasty and endoscopic methods. Tracheal resection combined with TEF required circular tracheal resection with disconnection of fistula. Adequate breathing through the natural airways was restored in all patients. There was no postoperative mortality. Three patients with baseline tracheal stenosis had favorable postoperative outcomes after circular tracheal resection. Four patients are at the final stage of treatment after laryngotracheoplasty and tracheal stenting. Patients after invasive mechanical ventilation for COVID-19 pneumonia are at high risk of cicatricial tracheal stenosis and require follow-up. Circular tracheal resection ensures early rehabilitation and favorable functional results. Laryngotracheoplasty is preferred if circular tracheal resection is impossible. This procedure ensures adequate debridement of tracheobronchial tree and respiratory support. Endoscopic measures are an alternative for open surgery, especially for intrathoracic tracheal stenosis and intractable tracheobronchitis.

STENT-IN-STENT TECHNIQUE FOR MANAGEMENT OF PERIPHERAL MALIGNANT ENDOBRONCHIAL OBSTRUCTION

TOPIC: Procedures TYPE: Medical Student/Resident Case Reports INTRODUCTION: Airway stenting is used to restore patency of airways with malignant obstruction. Stent-in-stent (SIS) technique has been used in central airway obstruction. We describe a case of malignant endobronchial obstruction in the right upper lobe (RUL) managed with SIS technique. CASE PRESENTATION: 56-year-old male with history of Laryngeal Carcinoma managed with surgical resection and chemo-radiation was transferred for management of recurrent hemoptysis and right lung atelectasis. He was tachypneic and hypoxic requiring 2L oxygen. Labs revealed leukocytosis, hemoglobin of 9.6gm/dl and no coagulopathy. CT Chest showed right lung atelectasis due to right mainstem endobronchial mass. Rigid bronchoscopy (RB) demonstrated a friable mass in the right main stem with frank blood in the central airway. Initially Diode laser was employed for removal of the pedunculated tumor originating in the RUL, followed by debulking with RB and cryoprobe from the right main stem and bronchus intermedius (BI). Rigid tamponade and argon plasma coagulation were used for hemostasis. BF-P190 Olympus scope was used to identify the distal airway in the RUL posterior segment and a 7x22 mm iCAST stent was placed for airway patency. Right middle lobe (RML) and lower lobe (RLL) airways were not localized at the time. A staged RB was performed a few days later. BF-P190 Olympus scope was used for inspection which revealed occlusion of distal end of stent with tumor, advancement of scope with mild pressure through the tumor revealed sub segmental airways, under fluoroscopy guidance a second 7x22mm iCAST stent was placed overlapping with the first stent. Additional tumor debulking from the BI revealed RLL segmental branches. Under direct visualization a 10x38 mm iCAST stent was placed to restore airway patency to the RLL. He remained stable off oxygen post procedure, with reinflation of the right lung. He was discharged with bronchodilators and hypertonic saline with significant improvement in his quality of life. DISCUSSION: Rigid bronchoscopy and airway stenting is commonly used for management of complex central airway obstruction. iCAST stent is a balloon expandable stainless steel stent that is fully encapsulated in two layers of polytetrafluoroethylene. The stent deployment is through the scope with the smallest size of 5x16mm and largest 10x38mm. The smaller size stent can be upsized with a larger sized balloon with the stent shortening in length. We present a SIS placement of two 7x22 mm iCAST stents in the airway likely traversing through the right hilar mass to establish airway patency, resulting in complete reexpansion of the lung. CONCLUSIONS: Peripheral airway stenting of occluded airway due to malignancy can result in lung reinflation, resulting in increased pulmonary reserves for patient to tolerate chemotherapy and radiation. We used SIS technique for customization and appropriate stenting of distal airway. REFERENCE #1: Sethi, Sonali, et al. "Clinical Success Stenting Distal Bronchi for 'Lobar Salvage’ in Bronchial Stenosis:” Journal of Bronchology & Interventional Pulmonology, vol. 25, no. 1, 2018, pp. 9–16, doi:10.1097/LBR.0000000000000422. REFERENCE #2: Majid A, Kheir F, Chung J, Alape D, Husta B, Oh S, Folch E.. Covered Balloon-Expanding Stents in Airway Stenosis. J Bronchology Interv Pulmonol. 2017 Apr;24(2):174-177. doi: 10.1097/LBR.0000000000000364.J Bronchology Interv Pulmonol. 2017. PMID: 28323735 DISCLOSURES: No relevant relationships by Muhammad Arif, source=Web Response no disclosure submitted for Ali Saeed; No relevant relationships by Hursh Sarma, source=Web Response No relevant relationships by Andrew Talon, source=Web Response No relevant relationships by Cindrel Tharumia Jagadeesan, source=Web Response

Utility of bronchoscopic intra-tumoral alcohol injection to restore airway patency

BackgroundIn cases of malignant airway obstruction, achieving airway patency using conventional bronchoscopic modalities can be challenging and may not be satisfactory. We aim to present our experience of using intra-tumoral alcohol injection (ITAI) to help achieve airway patency in malignant airway obstruction.MethodsA retrospective study of adult patients presenting with malignant airway obstruction who underwent bronchoscopy with ITAI at a university center between 2015 and 2020 was conducted. We present procedural and patients’ characteristics along with any additional bronchoscopic or systemic interventions received. Patients were classified based on airway patency response (assessed qualitatively by an interventional pulmonologist) into those with good response (≥50% improvement in airway patency) vs. those with low response (<50% improvement in airway patency).ResultsForty-two patients underwent ITAI, of which 34 (81%) had at least two bronchoscopies to evaluate response. The patient median age was 65.5 [interquartile range (IQR) 57.8–72]. Most patients had stage IV malignancy at the time of the bronchoscopy (57.1%) and had Eastern Cooperative Oncology Group (ECOG) performance status score of between 2–3. Eighty-two percent of the patients achieved good airway patency response at the conclusion of the procedures. The procedures were generally well-tolerated and only one patient had significant bleeding that was not directly related to ITAI and required intensive care unit monitoring for 24 hours after the procedure.ConclusionsDehydrated alcohol is readily available, inexpensive and a safe drug that can be potentially injected directly in malignant airway obstructive lesions in a multimodality approach to achieve airway patency when traditional modalities reach their limitation. Further studies are warranted to determine whether ITAI is superior to other interventional methods, explore its utilization to treat peripheral malignant tumors, as well as to standardize the treatment protocol and determine the effects of ITAI on patient symptoms and quality of life.

Airway Management of the Deformed Trachea Using T-Tube Stents in Patients with Mucopolysaccharidosis Type IVA.

Mucopolysaccharidosis (MPS) type IVA usually results in airway obstruction due to thoracic cage deformity and crowding of intrathoracic structures, causing tracheal compression by the tortuous innominate artery. To offer an alternative and effective method in dealing with the challenged deformity of the airway in patients with MPS type IVA. We present 3 patients with MPS type IVA who underwent airway stenting using Montgomery® T-tube stents. Three-dimensional reconstructed computed tomography was essential to design the T-tube and evaluate the anatomical relationship between the innominate artery and the trachea. The Y-shaped Montgomery® Pediatric Safe-T-Tube™ is more suitable for MPS type IVA. Regular follow-ups using fiberoptic bronchoscopy are necessary to evaluate the complications. All 3 patients had good outcomes during the follow-ups until present, despite the complication of granulation formation, which was resolved by revising the limbs of the T-tube. T-tube stents placed below the vocal cord may restore airway patency and preserve laryngeal function, including respiration, phonation, and swallowing, in patients with MPS type IVA.

The Role of Bronchoscopic Cryoablation in Management of Central Airway Obstruction

Central airway obstruction is one of respiratory emergency manifested as dyspnea, stridor and obstructive pneumonia. Most of central airway obstruction cases were treated with resection and surgery. Bronchoscopy is an initial modality to diagnose, stabilize the airway obstruction and evaluate for palliative treatment. Cryoablation is an evolving therapeutic bronchoscopic methods. Through rapid freeze–thaw cycles, cryoablation causes cell death and tissue necrosis or tissue adherence that can be used via the flexible or rigid bronchoscope. Cryoablation can safely restore airway patency and improve symptoms in patients with central airways obstruction from exophytic tumours. It is also used in the treatment of granulation tissue and benign strictures. Clinical studies showed improvement of dyspnea, cough, and hemoptysis with non-significant complications.

Using individualized three-dimensional printed airway models to guide airway stent implantation

Airway stents are used to manage central airway obstructions by restoring airway patency. Current manufactured stents are limited in shape and size, which pose issues in stent fenestrations needed to be manually created to allow collateral ventilation to airway branches. The precise location to place these fenestrations can be difficult to predict based on 2-dimensional computed tomography images. Inspiratory computed tomography scans were obtained from 3 patients and analysed using 3D-Slicer™, Blender™ and AutoDesk® Meshmixer™ programmes to obtain working 3D-airway models, which were 3D printed. Stent customizations were made based on 3D-model dimensions, and fenestrations into the stent were cut. The modified stents were then inserted as per usual technique. Two patients reported improved airway performance; however, stents were later removed due to symptoms related to in-stent sputum retention. In a third patient, the stent was removed a few weeks later due to the persistence of fistula leakage. The use of a 3D-printed personalized airway model allowed for more precise stent customization, optimizing stent fit and allowing for cross-ventilation of branching airways. We determine that an airway model is a beneficial tool for stent optimization but does not prevent the development of some stent-related complications such as airway secretions.

A REVIEW OF PALLIATIVE ENDOBRONCHIAL INTERVENTIONS PERFORMED IN PATIENTS WITH MALIGNANT AIRWAY OBSTRUCTION

SESSION TITLE: Cardiothoracic Surgery Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Malignant Airway Obstruction (MAO) results from various processes including direct invasion due to bronchogenic carcinoma, metastatic deposits with endobronchial obstructions, and extrinsic compression by mediastinal tumors and lymphadenopathies. Despite an overall poor prognosis, some patients may benefit from a palliative intervention with advanced endoluminal therapies. The ultimate goal is to restore airway patency, avoid hospital readmissions, and improve respiratory symptoms. Here, we present our experience in treating patients with MAO with endoluminal therapies including YAG laser, balloon tracho-bronchoplasties, and airway stenting. METHODS: From January 2018 to July 2020, we retrospectively reviewed 57 patients with inoperable malignant airway disease who underwent endoluminal airway interventions. Characteristics such as smoking history, type of procedure, necessity for re-intervention, and mortality within thirty days of intervention associated with the procedure were analyzed. Successful palliation was defined as decreased dyspnea and radiologic evidence of improved aeration of lung parenchyma. Categorical variables are descriptively summarized using percentages and continuous variables using mean and standard deviation. All statistical analyses were performed using SAS software, version 9.4 (SAS Institute Inc., Cary, NC). RESULTS: 57 patients underwent a total of 121 endoluminal interventions for MAO. 51% were females, with a mean age ± std of 66±14.7. 57% were prior or active smokers. The most common malignancies were squamous cell carcinoma (28%) and metastatic disease (19%). Endobronchial tumor debulking was performed in 60% of the patients with yag laser therapy. Airway stenting was performed in 63% of patients and balloon dilatation was performed in 40% of patients. Planned re-intervention within 12 weeks from index procedure was performed in 65 % of the patients. 75% of the patients experienced significant clinical improvement. Mortality at thirty days was 2%. CONCLUSIONS: Palliative endobronchial intervention remains an important tool in patients with advanced non resectable MAO as it can provide relief of respiratory symptoms and improve quality of life with a low risk of thirty day mortality. CLINICAL IMPLICATIONS: Palliative endobronchial interventions may be considered in patients with inoperable MAO as it provides palliation, reducing dyspnea and recurrent post obstructive atelectasis. DISCLOSURES: No relevant relationships by Angel Porras, source=Web Response no disclosure on file for Fernando Safdie; No relevant relationships by Anita Singh, source=Web Response No relevant relationships by Francico Ujueta, source=Web Response

Methods of surgical treatment of bilateral vocal fold paralysis.

Bilateral vocal fold paralysis presents as their complete or partial immobilisation. The median or paramedian position of vocal folds contributes to the narrowing of the airway at the level of the glottis and manifests as inspiratory dyspnoea. For many years iatrogenic injury of recurrent laryngeal nerves during thyroidectomy has been viewed as the most common underlying reason. It is very often a lifethreatening condition requiring not only corticosteroid administration and intubation, which only constitute a short-term symptomatic therapy, but also surgical intervention, including tracheostomy. The most common surgical methods implemented in bilateral vocal fold paralysis include posterior cordectomy, arytenoidectomy, and, more and more commonly, re-innervation. Other techniques used in restoring airway patency include laterofixation, botulinum toxin injection, and laryngeal stimulation, which is still under research. Stem cell and gene therapy are also being researched. Notably, the main purpose of surgical treatment is the provision of airway patency with the preservation of the phonatory and protective functions of the larynx.