Metallic stent and flexible bronchoscopy without fluoroscopy for acute respiratory failure

Abstract

Stent implantation has been reported to facilitate liberation from mechanical ventilation in patients with respiratory failure due to central airway disease. The present retrospective cohort study sought to evaluate the risk and benefit of stent implantation via bronchoscopy without fluoroscopic guidance in mechanically ventilated patients.From July 2001 to September 2006, 26 patients with acute respiratory failure were recruited. A bronchoscope was inserted through a mouth guard into the space between the tracheal wall and the endotracheal tube. A guide wire was inserted via the flexible bronchoscope to the lesion site. The bronchoscope was reintroduced through the endotracheal tube. Under bronchoscopic visualisation, the delivery catheter was advanced over the guide wire to deploy the stent.These procedures were successfully performed in 26 patients, with 22 stents placed in the trachea and seven in the main bronchus. Of the 26 patients, 14 (53.8%) became ventilator independent during their stay in the intensive care unit. Severe pneumonia was the most common cause, in seven (58.3%) out of 12 patients, for continued ventilator dependence after stenting. Granulation tissue formation was found in seven patients during the follow-up period.It is concluded that metallic stents can be safely implanted without fluoroscopic guidance in patients with respiratory failure, to facilitate ventilator independence.

Implantation of Metallic Stent Under Direct Visualization of Flexible Bronchoscope Without Fluoroscopic Guidance on Orotracheal Intubated Patients

“…Will the patient receive sufficient ventilation? The results of the previous research [10] and the present study all showed that patients received enough oxygen support during the operation.…”

“…Winding through an airway outside a tracheal tube needs more skill and time. It might be an important reason that the operation time of the present study was less than that of the previous study [10] . In addition, an ultrathin bronchoscope with an outer diameter of about 1.8-2.8 mm may be inserted simultaneously with a delivery catheter into a tracheal tube to implant a metallic stent.…”

“…Due to successfully solving the problems of airway stenosis, a stent implantation has been regarded as an effective method of liberating these patients from mechanical ventilation [9][10] . Rigid bronchoscopy with general anesthesia [11] and flexible bronchoscopy under fluoroscopic guidance [9] are the most common methods of stent implantation in mechanically ventilated patients, especially for those patients who are not appropriated for surgical intervention.…”

“…The diameter of a No. 22 Fr delivery catheter (Boston Scientific) used in the previous study [10] is 7.26 mm. It is bigger than the diameter of a bronchoscope.…”

“…This method produced relatively more sufficient ventilation and less air leakage. In the previous study [10] , the catheter passed outside the tube, and a bronchoscope was inserted through the tube. The diameter of a No.…”