Therapeutic Rigid Bronchoscopy Allows Level of Care Changes in Patients With Acute Respiratory Failure From Central Airways Obstruction

Complications Following Therapeutic Bronchoscopy for Malignant Central Airway Obstruction

“…34 Th is is in contrast to other studies showing that therapeutic bronchoscopy allows deescalation in the level of care. 35 However, those studies focused solely on patients with airway obstruction and acute respiratory failure requiring admission to the ICU prior to bronchoscopy. In such instances, therapeutic bronchoscopy oft en results in an immediate clinical improvement and deescalation in level of care, albeit perhaps not in the fi rst 24 h; however, that is a very small subset of all patients receiving therapeutic bronchoscopy.…”

“…Th e data suggest that over the fi rst 24 h, therapeutic bronchoscopy occasionally results in an increase in level of care required, although probably over the long term, quality of life and level of care required improve, consistent with previous studies. 12,35 Other limitations inherent to the study design are the possibility of residual confounding and confounding by indication. For example, the association between APC use and bleeding is probably not causal, but rather it is a refl ection of the fact that when bleeding occurs, an attempt to cauterize the lesion with APC is oft en made.…”

Rigid Bronchoscopy for Malignant Central Airway Obstruction from Small Cell Lung Cancer Complicated by SVC Syndrome

“…7) Emergent rigid bronchoscopy in these instances, however, remains a therapeutic option, even in patients older than age eighty 4) because it improves functional status, allows initiation of systemic therapy and prolongs survival. 2,3) SVC obstruction by lymph node metastasis into the right paratracheal or precarinal stations or by direct invasion of lung cancer can cause SVC syndrome in up to 10% of newly diagnosed SCLC. 8) Tumor growth in most cases is gradual, allowing sufficient time to develop adequate collateral circulation; however, many patients eventually develop headache, swelling of the face and neck and sometimes even enter a coma.…”

“…Prognosis is guarded and response to external beam radiation alone in the presence of critical airway narrowing is relatively poor. 1) Therapeutic rigid bronchoscopy often provides immediate relief from malignant CAO, 2,3) but the risks of intervention warrant careful consideration when patients have significant comorbidities such as a large mediastinal mass, SVC syndrome or very advanced age. 4,5) While reports on the coexistence of the SVC syndrome and CAO and their anesthesia-related complications, including periprocedural death, have been previously published, 5) a case of a patient with clinically overt SVC syndrome and critical CAO who underwent a rigid bronchoscopy has not been previously reported, to our knowledge.…”

Airway stent improves outcome in intubated oesophageal cancer patients

“…Among patients with obstruction of the trachea and main stem bronchi with tumour invasion, respiratory failure is one of the most severe complications. Due to advances in airway stents and insertion techniques, interventional bronchoscopic procedures have been reported to facilitate weaning from mechanical ventilation [4]. Moreover, covered self-expandable metallic stents have been used to seal off tracheo-oesophageal fistulas and to avoid aspiration symptoms [5].…”