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Lung India. 2020 Mar-Apr;37(2):114-119. doi: 10.4103/lungindia.lungindia_454_19.

Rigid bronchoscopic interventions for central airway obstruction - An observational study.

Author information

1
Department of Pulmonary Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India.
2
Department of Radiodiagnosis, SGPGIMS, Lucknow, Uttar Pradesh, India.
3
Department of Anesthesiology, SGPGIMS, Lucknow, Uttar Pradesh, India.

Abstract

Background:

Central airway obstruction (CAO) is a significant cause of morbidity and mortality in patients with thoracic malignancies. In this prospective study, we describe the role of rigid bronchoscopy (RB) in the multimodality management of CAO.

Methods:

Prospective description of different rigid bronchoscopic techniques used for CAO between July 2016 and July 2019.

Results:

A total of 152 procedures (124 therapeutic/palliative and 28 diagnostics) in 111 adults and 10 pediatric patients were performed. The mean age in 111 adults (66 males) and 10 pediatric (5 males) patients were 45.4 ± 15.8 (range 16-80) and 5.4 ± 3.6 (range 1-10) years, respectively. Palliation of the airway obstruction (48.8%) and establishment of diagnosis (23.2%) were the main indications of RB in our study. Mechanical debulking in 53 (57%) and airway dilatation in 40 (43%) patients were the most utilized interventions during the palliative or therapeutic RB. There was a significant decrease in mean (modified Medical Research Council) dyspnea scale from 3.9 ± 1.0 to 1.42 ± 0.63 and increase in mean Visual Analogue Scale from 2.06 ± 0.74 to 8.7 ± 0.54 after the procedure (P < 0.0001). Additional therapy was undertaken in 38 (31.4%) of 121 patients, and surgical excision was the primary form of definitive treatment in 17 patients Moderate bleeding was encountered in 13.3% of the procedures mainly in the diagnostic RB. The mean procedure duration was 28.4 (range, 11-49) min and 13.2 (7-22) min in the adults and pediatric patients, respectively. A total of 31 patients succumbed to the illness due to the progressive nature of their disease.

Conclusions:

An individualized approach to interventional procedures is safe and effective way to achieve and maintain palliation of CAO. RB with multimodality treatment achieves the goal in majority of the patients.

KEYWORDS:

Central airway obstruction; diagnostic rigid bronchoscopy; interventional pulmonology; lung cancer; therapeutic rigid bronchoscopy; tracheal stenosis

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