School of Medicine and Health Sciences Poster Presentations

Title

A Case Series of Central Airway Obstruction Treated with Rigid Bronchoscopy

Document Type

Poster

Abstract Category

Cardiology/Cardiovascular Research

Keywords

rigid bronchoscopy, central airway obstruction

Publication Date

Spring 5-1-2019

Abstract

We report our experience in the management of Central Airway Obstruction (CAO) with Rigid Bronchoscopy (RB) in the Washington DC Veteran population. This was a retrospective study in patients with CAO treated with RB between March 2017 and September 2018. Imaging studies, including computed tomography (CT) scans and positron emission tomography/computed tomography (PET/CT) scans, were used to determine the etiology, degree of airway stenosis, anatomic and histopathological characteristics. A total of 12 patients underwent RB with a preoperative diagnosis of CAO. Mean age was 65.9. 10 patients (83%) were male. 7 patients (58%) were African American with the remainder being Caucasian. 10 patients (83%) had a smoking history. The majority of CAOs were caused by malignant tumors in 10 patients (83%) of which, eight, were due to squamous cell carcinoma (SCC) of the lung. One patient had stage IV pulmonary adenocarcinoma. One case of CAO due to metastatic prostate cancer. Two cases secondary to benign tracheal stenosis; an aberrant subclavian artery aneurysm and secondary to prolonged intubation. Five patients had stenotic lesions located in the right mainstem bronchus, five in the left mainstem bronchus, and two with lesions in the trachea. 3 patients had a preprocedural need for positive pressure ventilation (PPV), all three patients were successfully extubated or weaned off PPV post procedure. 8 patients (67%) underwent balloon dilation, 4 (33%) had argon plasma coagulation, 3 (25%) underwent laser debulking, and 5 patients (42%) received a stent across the stenosis, including four silicone covered, self-expanding metal stents and one full silicone stent. Stenotic relief was achieved transoperatively in 10 patients (83%). Complications included: All cause 30-day mortality in 4 patients (33%), procedural mortality 0%, readmission for airway compromise in 3 patients (25%), stent migration in 1 patient (8.3%), hemodynamic instability in 1 patient (8.3%), procedural hypoxemia (<85% by pulse oximetry) in 1 patient (8.3%). There were no cases of pneumothorax or bleeding requiring transfusion. We conclude that CAO is a complex clinical syndrome frequently encountered with later staging of lung malignancies in our veteran population. Due to the scarcity of data available amongst veterans, it is necessary to report additional cases, since veterans are at increased risk of pulmonary malignancies due to a higher smoking incidence and later detection. Veterans with advanced pulmonary malignancies have increased surgical risk. RB, with or without stenting, is an important minimally invasive procedure for relieving airway compromise.

Open Access

1

Comments

Presented at Research Days 2019.

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A Case Series of Central Airway Obstruction Treated with Rigid Bronchoscopy

We report our experience in the management of Central Airway Obstruction (CAO) with Rigid Bronchoscopy (RB) in the Washington DC Veteran population. This was a retrospective study in patients with CAO treated with RB between March 2017 and September 2018. Imaging studies, including computed tomography (CT) scans and positron emission tomography/computed tomography (PET/CT) scans, were used to determine the etiology, degree of airway stenosis, anatomic and histopathological characteristics. A total of 12 patients underwent RB with a preoperative diagnosis of CAO. Mean age was 65.9. 10 patients (83%) were male. 7 patients (58%) were African American with the remainder being Caucasian. 10 patients (83%) had a smoking history. The majority of CAOs were caused by malignant tumors in 10 patients (83%) of which, eight, were due to squamous cell carcinoma (SCC) of the lung. One patient had stage IV pulmonary adenocarcinoma. One case of CAO due to metastatic prostate cancer. Two cases secondary to benign tracheal stenosis; an aberrant subclavian artery aneurysm and secondary to prolonged intubation. Five patients had stenotic lesions located in the right mainstem bronchus, five in the left mainstem bronchus, and two with lesions in the trachea. 3 patients had a preprocedural need for positive pressure ventilation (PPV), all three patients were successfully extubated or weaned off PPV post procedure. 8 patients (67%) underwent balloon dilation, 4 (33%) had argon plasma coagulation, 3 (25%) underwent laser debulking, and 5 patients (42%) received a stent across the stenosis, including four silicone covered, self-expanding metal stents and one full silicone stent. Stenotic relief was achieved transoperatively in 10 patients (83%). Complications included: All cause 30-day mortality in 4 patients (33%), procedural mortality 0%, readmission for airway compromise in 3 patients (25%), stent migration in 1 patient (8.3%), hemodynamic instability in 1 patient (8.3%), procedural hypoxemia (<85% by pulse oximetry) in 1 patient (8.3%). There were no cases of pneumothorax or bleeding requiring transfusion. We conclude that CAO is a complex clinical syndrome frequently encountered with later staging of lung malignancies in our veteran population. Due to the scarcity of data available amongst veterans, it is necessary to report additional cases, since veterans are at increased risk of pulmonary malignancies due to a higher smoking incidence and later detection. Veterans with advanced pulmonary malignancies have increased surgical risk. RB, with or without stenting, is an important minimally invasive procedure for relieving airway compromise.