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Funes‐Ferrada R, Barrios‐Ruiz A, Yu Lee‐Mateus A, Johnson MM, Fernandez‐Bussy S, Abia‐Trujillo D. Long-term pneumatic stenting with positive expiratory pressure therapy for severe expiratory central airway collapse. Respirol Case Rep 2024; 12:e01367. [PMID: 38725709 PMCID: PMC11079437 DOI: 10.1002/rcr2.1367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 04/28/2024] [Indexed: 05/12/2024] Open
Abstract
Expiratory central airway collapse (ECAC) comprising excessive central airway collapse (EDAC) and tracheobronchomalacia. Treatment is challenging for severe cases that are not candidates for surgical management. We report a case of severe ECAC successfully managed with continuous positive airway pressure (CPAP) therapy. A 75-year-old female patient status post right pneumonectomy, presented with chronic cough. Dynamic bronchoscopy evaluation showed severe EDAC which improved with intraprocedural noninvasive positive pressure (NIPPV) therapy. Due to patients' comorbidities, she was not a candidate to surgical tracheobronchoplasty. Therefore, we attempted pneumatic stenting with long-term CPAP therapy resulting in improvement of symptoms and functional capacity. The long-term efficacy of pneumatic stenting has not been clearly established yet. Literature review of management of ECAC with NIPPV consist primarily of case reports and there is only one clinical trial being conducted to assess the efficacy of CPAP therapy in ECAC. While NIPPV arises as a sufficient alternative for management of severe ECAC, larger scale studies are needed to prove the real efficacy of NIPPV in this setting.
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Affiliation(s)
| | - Alanna Barrios‐Ruiz
- Division of Pulmonary, Allergy, and Sleep MedicineMayo ClinicJacksonvilleFloridaUSA
| | | | - Margaret M. Johnson
- Division of Pulmonary, Allergy, and Sleep MedicineMayo ClinicJacksonvilleFloridaUSA
| | | | - David Abia‐Trujillo
- Division of Pulmonary, Allergy, and Sleep MedicineMayo ClinicJacksonvilleFloridaUSA
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Bøgh M, Gade S, Larsen DG, Schytte S, Pedersen U, Kjærgaard T. Predictors in the treatment of malignant central airway obstruction with silicone stents. Eur Arch Otorhinolaryngol 2024; 281:1457-1462. [PMID: 38183453 PMCID: PMC10858089 DOI: 10.1007/s00405-023-08365-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 11/19/2023] [Indexed: 01/08/2024]
Abstract
PURPOSE To examine the role of the silicone stent in palliation of malignant central airway obstruction and identify potential preprocedural predictors for postprocedural outcome. METHODS Patients treated with endoscopic insertion of tracheobronchial silicone stents for malignant central airway obstruction at Aarhus University Hospital from 2012 to 2022 were identified from electronic medical records. Statistical analyses were carried out to identify factors affecting Days Alive and Out of Hospital, complications and overall survival. RESULTS 81 patients underwent a total of 90 tracheobronchial stent insertions. Days Alive and Out of Hospital (DAOH) for the first 30 days were affected negatively by urgent intervention, p < 0.001, preprocedural non-invasive respiratory support, p < 0.001, and preprocedural intubation, p = 0.02. Post-procedural oncological treatment was associated with a significant improved DAOH, p = 0.04. Symptomatology and lesion characteristics were not significantly associated with any impact on DAOH. Overall survival was poor (mean survival was 158 days), and only significantly affected by severe degree of dyspnea, p = 0.02, and postprocedural oncological treatment, p < 0.001. Complication where registered in 25.6% of cases within the first 30 days was observed. Procedure-related mortality was 3.7%. Based on chart annotations by an ENT-surgeon, 95% of the patients experienced relief of symptoms following stent insertion. CONCLUSIONS Palliative tracheobronchial airway stenting with silicone stents is found to have a beneficial impact, more research is required for identification of predictors for postprocedural outcome based on preprocedural classifications.
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Affiliation(s)
- Mads Bøgh
- Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Søren Gade
- Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | | | - Sten Schytte
- Otorhinolaryngology, Head and Neck Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Ulrik Pedersen
- Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas Kjærgaard
- Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark.
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Santos Portela AM, Radu DM, Onorati I, Peretti M, Freynet O, Uzunhan Y, Jerbi S, Martinod E. [Interventionnal bronchoscopy for the treatment of tracheobronchomalacia]. Rev Mal Respir 2023; 40:700-715. [PMID: 37714754 DOI: 10.1016/j.rmr.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/18/2023] [Indexed: 09/17/2023]
Abstract
Tracheobronchomalacia is usually characterized by more than 50% expiratory narrowing in diameter of the trachea and the bronchi. The expiratory collapse includes two entities: (1) the TBM related to the weakness of the cartilaginous rings, and (2) the Excessive Dynamic Airway Collapse (EDAC) due to the excessive bulging of the posterior membrane. Patients have nonspecific respiratory symptoms like dyspnea and cough. Diagnosis is confirmed by dynamic tests: flexible bronchoscopy and/or computed tomographic scan of the chest. There are different forms of tracheobronchomalacia in adults: primary (genetic, idiopathic) or secondary to trauma, tracheotomy, intubation, surgery, transplantation, emphysema, infection, inflammation, chronic bronchitis, extrinsic compression; or undiagnosed in childhood vascular rings. Some management algorithms have been proposed, but no specific recommendation was established. Only symptomatic patients should be treated. Medical treatments and noninvasive positive pressure ventilation should be the first line therapy, after evaluation of various quality measures (functional status, performance status, dyspnea and quality of life scores). If symptoms persist, therapeutic bronchoscopy permits: (1) patient's selection by stent trial to determine whether patient benefit for surgical airway stabilization; (2) malacic airways stenting in patients who are not surgical candidates, improving QOL despite a high complication rate; (3) the management of stent-related complication (obstruction, plugging, migration granuloma); (4) alternative therapeutics like thermo-ablative solution. Lasty, the development of new types of stents would reduce the complication rates. These different options remained discussed.
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Affiliation(s)
- A M Santos Portela
- Département de chirurgie thoracique et vasculaire, faculté de médecine SMBH, Assistance publique-Hôpitaux de Paris, hôpitaux universitaires Paris Seine-Saint-Denis, hôpital Avicenne, université Sorbonne Paris Nord, Bobigny, France
| | - D M Radu
- Département de chirurgie thoracique et vasculaire, faculté de médecine SMBH, Assistance publique-Hôpitaux de Paris, hôpitaux universitaires Paris Seine-Saint-Denis, hôpital Avicenne, université Sorbonne Paris Nord, Bobigny, France
| | - I Onorati
- Département de chirurgie thoracique et vasculaire, faculté de médecine SMBH, Assistance publique-Hôpitaux de Paris, hôpitaux universitaires Paris Seine-Saint-Denis, hôpital Avicenne, université Sorbonne Paris Nord, Bobigny, France
| | - M Peretti
- Département de chirurgie thoracique et vasculaire, faculté de médecine SMBH, Assistance publique-Hôpitaux de Paris, hôpitaux universitaires Paris Seine-Saint-Denis, hôpital Avicenne, université Sorbonne Paris Nord, Bobigny, France
| | - O Freynet
- Département de pneumologie, faculté de Médecine SMBH, Assistance publique-Hôpitaux de Paris, hôpitaux universitaires Paris Seine-Saint-Denis, hôpital Avicenne, université Sorbonne Paris Nord, Bobigny, France
| | - Y Uzunhan
- Département de pneumologie, faculté de Médecine SMBH, Assistance publique-Hôpitaux de Paris, hôpitaux universitaires Paris Seine-Saint-Denis, hôpital Avicenne, université Sorbonne Paris Nord, Bobigny, France
| | - S Jerbi
- Département d'anesthésie, faculté de médecine SMBH, Assistance publique-Hôpitaux de Paris, hôpitaux universitaires Paris Seine-Saint-Denis, hôpital Avicenne, université Sorbonne Paris Nord, Bobigny, France
| | - E Martinod
- Département de chirurgie thoracique et vasculaire, faculté de médecine SMBH, Assistance publique-Hôpitaux de Paris, hôpitaux universitaires Paris Seine-Saint-Denis, hôpital Avicenne, université Sorbonne Paris Nord, Bobigny, France.
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