Managing obstruction of the central airways

Abstract

Lung cancer is the most common cause of cancer death in Australia, Europe and the USA. Up to 20-30% of these cancers eventually affect the central airways and result in reduced quality of life, dyspnoea, haemoptysis, post-obstructive pneumonia and ultimately death. Non-malignant processes may also lead to central airway obstruction and can have similar symptoms. With the development of newer technologies, the last 20 years have seen the emergence of the field of interventional pulmonology to deal specifically with the diagnosis and management of thoracic malignancy, including obstruction of the central airways. This review discusses the pathology, pre-procedure work-up and management options for obstructing central airway lesions. Several treatment modalities exist for dealing with endobronchial pathology with local availability and expertise guiding choice of treatment. While the literature lacks large, multicentre, randomized studies defining the optimal management strategy for a given problem, there is growing evidence from numerous case studies of improved physiology, of quality of life and possibly of survival with modern interventional techniques.

Endotracheal Tube Management and Obstructed Airway

“…31 In terms of nonmalignant central airway obstructions, the most likely cause includes tracheal stenosis secondary to postintubation or posttracheostomy injury. 32 Anesthesia Careful anesthetic management in the evaluation and treatment of central airway obstruction is a point of distinct emphasis. 33 As mentioned previously, clear communication between the surgeon and an experienced anesthesiologist is a key principle.…”

The anesthesia of trachea and bronchus surgery

“…Extrathoracic obstructions indicate flattening in the inspiratory limb of the flow-volume loop. However, fixed intra-and extrathoracic obstructions show flattening in the inspiratory and expiratory limbs (2,7). A baseline value of arterial blood gas analysis may be a guide for postoperative management.…”

“…This tube is connected to a sterile anesthetic circuit, across the surgical field. Ventilation is maintained by the anesthesiologist and confirmed by evaluating chest inflation, peripheral oxygen saturation, ETCO 2 , and blood gas analysis (8,11). Resection of the tracheal lesion is completed with circumferential dissection, and anastomosis is then started.…”

“…Disorders of central airway lead to disturbing symptoms such as cough, dyspnea, stridor, tachypnea, and hemoptysis (1)(2)(3). The trachea and bronchus surgery are mainly applied to stenosis, traumatic injury and tumors (4).…”

Feasibility of Applying Real-time Optical Imaging During Bronchoscopic Interventions for Central Airway Obstruction

“…[1][2][3] These include airway dilation, tumor ablation or resection, and the insertion of endobronchial stents. [1][2][3] These include airway dilation, tumor ablation or resection, and the insertion of endobronchial stents.…”