Treatment Of Central Airway Obstruction Research Articles

Therapeutic bronchoscopy facilitates liberation from mechanical ventilation and improves quality of life for critically ill patients with central airway obstruction.

Central airway obstruction (CAO) remains a challenging disease for both patients who are suffering from it and for physicians who are managing it. Patients will frequently present with acute symptoms of respiratory failure that require management in an intensive care unit (ICU). While the true prevalence and incidence of CAO in the ICU setting is unknown, recent estimates suggest that approximately 20–30% of patients with a cancer diagnosis may present with CAO or develop it after diagnosis. Therapeutic bronchoscopy focuses on performing minimally invasive procedures using multiple ablative modalities to recanalize the central airway and alleviate the obstruction. While procedures are usually technically successful, they appear to be underutilized. An individually tailored approach is often used based on patient characteristics, operator preference, and available equipment. After therapeutic bronchoscopy procedures are completed, many patients are successfully liberated from mechanical ventilation (MV) or immediately transferred out of the ICU. Data reviewing the effects of therapeutic bronchoscopy have also shown success in palliation of symptoms, with significant improvement in subjective measures such as patient quality of life and dyspnea and objective values like pulmonary function studies. Given the potential benefits with a low risk profile and high likelihood of technical success, treatment of CAOs with therapeutic bronchoscopy represents a reasonable consideration for patients with acute respiratory failure in the ICU.

Endobronchial management of malignant central airway obstruction: the first 6-year single center experience

Objectives: Central airway obstruction (CAO) develops in 20-30% of lung malignancies during the disease. The symptoms related to obstruction often result in poor quality of life and poor prognosis. Interventional bronchoscopic treatments are now recommended in guidelines to improve quality of life and symptom palliation in this patient group. In our study, we aimed to determine the efficacy and safety of our methods in the malignant CAO caused by endobronchial exophytic tumors. Methods: Between May 2012 and August 2018, 432 endobronchial debulking procedures were performed in 388 patients with symptomatic malignant CAO due to endobronchial exophytic or mixed lesions. Results: Primary lung tumors were the most common cause of airway stenosis (84.0%). The most common debulking technique was argon plasma coagulation assisted mechanical debridement (APC+MD) (79.9%). Airway patency was achieved with additional stents (10.2%) in the operations. The success rate of airway patency was 85.5% in APC+MD method, 75.6% in cryorecanalisation method, 91.7% in electrocautery assisted MD method, 100% in MD method and overall success rate was 85.4%. Stent use rate was significantly higher in the stenosis around main carina (42.9%) than in other localizations (p < 0.001). The overall serious complication rate was 2.1%. Procedure-related dead rate was 0.2%. Conclusions: Endobronchial treatment of malignant CAO with interventional bronchoscopic procedures is effective and safe. The first 6 years of experience in our interventional pulmonary clinic show that it has similar characteristics with the world experience in the endobronchial treatment of malignant CAO.

Cryotherapy and electrocautery in the management of malignant endobronchial neoplasms

Background Central airway obstruction is a problem facing all medical and surgical specialists caring for patients with chest diseases. Bronchoscopic cryotherapy (CRYO) and electrocautery (EC) are two different techniques used for the management of endobronchial lesions, and they have a role in palliative treatment of malignant central airway lesions. Aim The aim of the work was to compare between CRYO and EC in the management of malignant endobronchial neoplasms. Patients and methods A prospective study was conducted on 40 patients with malignant endobronchial mass who were selected for bronchoscopic CRYO and EC. Thirty-one men and nine women, with age range from 25 to 65years were included in this study. Bronchoscopic CRYO and EC were performed under local anesthesia using a flexible fiberoptic bronchoscope. Results CRYO and EC procedures provided significant improvement of dyspnea (P Conclusion EC and CRYO are effective modalities of endobronchial debulking in the treatment of central airway obstruction associating endobronchial malignancy. They relieve symptoms, improve pulmonary function tests, arterial blood gas parameters, and quality of life in a significant way; moreover they are easy, safe, and cheap with minimal complications.

PUB061 The Efficacy of Electrocautery Using Wire Snare as the Primary Ablation Modality for Malignant and Benign Airway Obstruction

Endobronchial electrocautery has not been studied extensively, but a growing experience has demonstrated that, similar to laser, it can achieve high success rates for the relief of central airway obstruction with favorable safety profile. In our institution, we use electrocautery rather than laser as the first-line heat therapy for central airway obstruction. In this study we reviewed our experience with electrocautery using wire snare with focus on its efficacy and safety. A retrospective review of all patients undergoing endobronchial electrocautery using wire snare alone at our institution between 2010 and 2015. Data on efficacy (luminal patency, symptomatic, radiographic, or physiologic improvement) and safety (time, bleeding, complication rate) were collected. Five patients underwent electrocautery procedure with wire snare. Of these, 4 patients had malignances (4 metastatic tumors; 1 lung, 1 colon, 1 renal, 1 melanoma) and 1 had benign (1 schwannoma). The snare wire was used as a biopsy technique for all patients, and resulted in the establishment of a diagnosis. Endoscopic improvement was seen in 100% of patients. Eighty percent of patients reported symptomatic improvement. Radiographic examination revealed luminal improvement in 100%. There have been no major complications while utilizing the wire snare, whereas minor bleeding was occurred in 1 patient who was needed extra procedure by blunt cautery probe for hemostasis. Mean procedure time was 31min. Endobronchial electrocautery using snare probe is effective and safe when used as an ablative modality in malignant and benign airway obstruction for selected patients. Compare to laser, this procedure may be equally effective and safe with significantly lower equipment cost. Further study such as well-designed prospective trial comparing laser and electrocautery is necessary to establish the appropriate role of each modality in the treatment of central airway obstruction.

Self-expanding Y stents in the treatment of central airway stenosis: a retrospective analysis

Central airway obstruction (CAO) is a life-threatening situation. Stent insertion re-establishes patency of the central airways. Self-expanding metallic Y stents have been available since 2005, widening the spectrum of interventional bronchoscopic techniques. Retrospective analysis of all patients treated for CAO with a self-expanding metallic Y stent at the Thoraxklinik Heidelberg between May 2005 and January 2009. A total of 43 patients aged 26-81 had a metallic Y stent inserted endoscopically for the treatment of CAO; 39 of these patients (90.7%) had CAO due to malignant disease, four patients (9.3%) due to benign disease. In all 43 patients, the Y stent was deployed without any complications. A longitudinal follow up was possible in 32 of the 43 patients. The stents remained in situ for an average of 107.1 days (range 1-640 days). In 29 patients with malignant CAO the stenosis was successfully overcome with a Y stent; 11 of these patients died within 6 weeks following stent insertion. On follow up the remaining 18 patients showed immediate improvement of dyspnoea. Eight out of the 18 patients (44.4%) tolerated the stent without problems, two (11.1%) required further stenting, six (33.3%) had complications such as increased secretions, cough, dyspnoea or granulation tissue formation. The stent was removed in one patient (5.6%) due to increased secretions, and in another (5.6%) as the stent was no longer required due to successful tumour-specific therapy. Placement of Y stents in symptomatic CAO allows for quick relief of symptoms. Severe complications are rare. Stent removal is possible after successful treatment of the primary tumour. However, the prognostic indicator for survival is the underlying malignancy.

SEVERE TRACHEAL SELF-EXPANDING METAL STENT (SEMS) COMPLICATION WITH MIGRATION AND GRANULATION TISSUE STENOSIS REQUIRING EXTRACTION

INTRODUCTION: Self-Expanding Metallic Stents (SEMS) are an increasingly common pulmonary procedure due to their easy flexible bronchoscopic insertion. Airway stenting offers a valuable tool for treatment of Central Airway Obstruction (CAO) secondary to malignant or benign disease. However, in patients with benign airway disease, stent complications are upward to 50%, prompting a 2005 FDA advisory emphasizing patient selection criteria. Injudicious use in non-malignant disease increases the frequency of severe early and late complications due to strut fracture, mucosal erosion, migration, or granulation tissue stenosis –requiring urgent interventional trained pulmonary expertise in SEMS extraction.

Bronchoscopy simulation: a brief review

More than 500,000 flexible bronchoscopies are performed annually by chest physicians in the United States (Ernst et al., Chest 123:1693-1717, 2003). Indications include diagnosis of lung cancer and airway tumors, benign strictures, pulmonary infections, and treatment of central airway obstruction, emphysema, and intraepithelial lesions such as carcinoma in-situ. Anesthesiologists, cardiothoracic and trauma surgeons, otolaryngologists, and critical are physicians also perform this procedure as part of difficult airway management, intubation or airway inspection and bronchial toilet. Compared to the expanding body of simulation-related literature that is available in other procedural fields, however, the volume of published work relating to bronchoscopy is scant. The purpose of this paper is to provide an overview of the available literature pertaining to the use of simulation in bronchoscopy education, and to demonstrate how this limited yet valuable body of work lays a foundation for the future use of simulator-based bronchoscopy training.

Microdebrider Bronchoscopy: A New Tool for the Interventional Bronchoscopist

We report our experience with a new airway tool, the microdebrider, in treating central airway obstruction. From April 2002 to April 2004, 23 patients undergoing treatment of central airway obstruction were managed with the microdebrider. All procedures were done under general anesthesia with either a rigid bronchoscope (19 patients) or a suspension laryngoscope (4 patients). The microdebrider was used in an oscillating mode with rotation speeds of 1,000 to 3,000 rpm to resect obstructing tissue. Fourteen patients (61%) had tracheal granulation tissue from prior intubation or tracheostomy, 6 (26%) had idiopathic subglottic stenosis, and 3 (26%) had malignant disease. Obstructing lesions were rapidly removed in all patients with interventions lasting between 2 and 15 minutes. There were no procedure-related complications. No patients required reoperation for airway obstruction in follow-up ranging from 1 to 24 months. Microdebrider bronchoscopy is a new technique that allows for precise, rapid, and safe removal of lesions obstructing the central airways. Complications of thermal modalities such as airway injury, tracheoesophageal fistulas, and airway fires can be avoided.

Central airway obstruction.

Central airway obstruction is a problem facing all medical and surgical subspecialists caring for patients with chest diseases. The incidence of this disorder appears to be rising because of the epidemic of lung cancer; however, benign causes of central airway obstruction are being seen more frequently as well. The morbidity is significant and if left untreated, death from suffocation is a frequent outcome. Management of these patients is difficult, but therapeutic and diagnostic tools are now available that are beneficial to most patients and almost all airway obstruction can be relieved expeditiously. This review examines current approaches in the workup and treatment of patients suffering from airway impairment. Although large, randomized, comparative studies are not available, data show significant improvement in patient outcomes and quality of life with treatment of central airway obstruction. Clearly, more studies assessing the relative utility of specific airway interventions and their impact on morbidity and mortality are needed. Currently, the most comprehensive approach can be offered at centers with expertise in the management of complex airway disorders and availability of all endoscopic and surgical options.

Treatment of Central Airway Obstruction : Endobronchial Polypectomy Under Endoscopic Electrosurgery Using a High Frequency to Generate Heat in Five Cases

Treatment of Central Airway Obstruction : Endobronchial Polypectomy Under Endoscopic Electrosurgery Using a High Frequency to Generate Heat in Five Cases