Therapeutic Rigid Bronchoscopy Intervention for Malignant Central Airway Obstruction Improves Performance Status to Allow Systemic Treatment

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Edward Y.C. Lee ◽  
Annette M. McWilliams ◽  
Matthew R. Salamonsen
2020 ◽  
Vol 90 (4) ◽  
Author(s):  
Ram Niwas ◽  
Gopal Chawla ◽  
Puneet Pareek ◽  
Nishant Kumar Chauhan ◽  
Naveen Dutt

Critical central airway obstruction has always been a dreaded complication to which interventional pulmonologist commonly encounters. There have been various modalities which are used for the management and palliation, which includes mechanical coring, laser, cryoextraction, electrocautery and airway stenting. Rigid bronchoscopy with or without jet ventilation has been corner stone of therapeutics and palliation of central airway obstruction. There are only a few conditions where it is not possible to use rigid bronchoscopy. Here we report a case of metastatic tracheal tumour which presented with critical airway obstruction in a patient who had atlantoaxial instability (AAI) due to rheumatoid arthritis. Here we used endobronchial ultrasound scope (EBUS) via esophageal route, i.e. EUS-B guided approach for sampling of the tracheal tumour, and intratumoral chemotherapy was instilled in multiple sessions, which resulted in shrinking of tumour, thus relieving the critical airway obstruction. This is the first report of using EUS-B approach for intratumoral chemotherapy for tracheal tumors. Bronchoscopic intratumoral chemotherapy therapy (BITC) in tracheal tumors is also one of the options but has not been explored much and there has been a dearth of literature for it.


CHEST Journal ◽  
2021 ◽  
Vol 160 (4) ◽  
pp. A1597
Author(s):  
Samiksha Gupta ◽  
Mukund Tiwari ◽  
Miloni Parmar ◽  
Fernando Figueroa Rodriguez ◽  
Taha Khan

2019 ◽  
Vol 6 (1) ◽  
pp. e000429 ◽  
Author(s):  
Cyrus Daneshvar ◽  
William Euan Falconer ◽  
Mohammed Ahmed ◽  
Abdul Sibly ◽  
Madeleine Hindle ◽  
...  

IntroductionCentral airway obstruction (CAO) is a life-threatening complication of lung cancer. The prevalence of CAO in lung cancer patients is unknown. We audited CAO burden to inform our local cancer service.MethodsThis is a cohort review of all new lung cancer diagnoses between 1 November 2014 and 30 November 2015. CAO was defined by CT appearance. CT scans and routine patient records were followed up to 30 November 2018 to determine the prevalence of CAO at diagnosis; the characteristics of patients with prevalent CAO; mortality (using survival analysis); and incident CAO over follow-up.ResultsOf 342 new lung cancer diagnoses, CAO prevalence was 13% (95% CI 10% to 17%; n=45/342). Dedicated CT scan review identified missed CAO in 14/45 (31%) cases. In patients with prevalent CAO, 27/44 (61%) had a performance status of ≤2, 23/45 (51%) were diagnosed during an acute admission and 36/44 (82%) reported symptoms. Treatments were offered to 32/45 (71%); therapeutic bronchoscopy was performed in only 8/31 (26%) eligible patients. Median survival of patients with prevalent CAO was 94 (IQR 33–274) days. Multivariate analysis, adjusting for age, gender and disease stage, found CAO on index CT scan was independently associated with an increased hazard of death (adjusted HR 1.78 (95% CI 1.27 to 2.48); p=0.001). In total, 15/297 (5%) developed CAO during follow-up (median onset 340 (IQR 114–551) days). Over the audit period, 60/342 (18%; 95% CI 14% to 22%) had or developed CAO.DiscussionsThis is the first description of CAO prevalence in 40 years. Patients with prevalent CAO had a higher mortality. Our data provide a benchmark for service planning.


2019 ◽  
Vol 48 (1) ◽  
pp. 181-191 ◽  
Author(s):  
Joshua B. Gafford ◽  
Scott Webster ◽  
Neal Dillon ◽  
Evan Blum ◽  
Richard Hendrick ◽  
...  

2019 ◽  
Author(s):  
Ju-Mei Ng

There has been a marked increase in the number and complexity of airway procedures performed both in the operating room and procedural areas. The anesthesiologist is challenged with establishing a patent shared airway and maintaining adequate gas exchange in patients with compromised airways and/or respiratory function. This review presents a general approach to the patient presenting for an airway procedure and highlights the commonly occurring complications. Airway fire, bleeding, and airway disruption or obstruction may occur. Some of the newer interventional bronchoscopic procedures are introduced, with emphasis on anesthetic implications. A more detailed discussion surrounds the anesthetic management of central airway obstruction and airway stenting. This review contains 8 figures, 5 tables, 30 references.  Key Words: anesthesia for flexible bronchoscopy, anesthesia for rigid bronchoscopy, airway stenting, bronchoscopy, central airway obstruction, interventional pulmonology, total intravenous anesthesia, ventilation


Sign in / Sign up

Export Citation Format

Share Document