Therapeutic bronchoscopy facilitates liberation from mechanical ventilation and improves quality of life for critically ill patients with central airway obstruction

Abstract

Central airway obstruction (CAO) remains a challenging disease for both patients who are suffering from it and for physicians who are managing it. Patients will frequently present with acute symptoms of respiratory failure that require management in an intensive care unit (ICU). While the true prevalence and incidence of CAO in the ICU setting is unknown, recent estimates suggest that approximately 20-30% of patients with a cancer diagnosis may present with CAO or develop it after diagnosis. Therapeutic bronchoscopy focuses on performing minimally invasive procedures using multiple ablative modalities to recanalize the central airway and alleviate the obstruction. While procedures are usually technically successful, they appear to be underutilized. An individually tailored approach is often used based on patient characteristics, operator preference, and available equipment. After therapeutic bronchoscopy procedures are completed, many patients are successfully liberated from mechanical ventilation (MV) or immediately transferred out of the ICU. Data reviewing the effects of therapeutic bronchoscopy have also shown success in palliation of symptoms, with significant improvement in subjective measures such as patient quality of life and dyspnea and objective values like pulmonary function studies. Given the potential benefits with a low risk profile and high likelihood of technical success, treatment of CAOs with therapeutic bronchoscopy represents a reasonable consideration for patients with acute respiratory failure in the ICU.

Airway Stents in Interventional Pulmonology

“…In such situations, the feasibility of airway stenting under moderate sedation should be considered. It is important to mention, however, that although therapeutic bronchoscopy and airway stenting may pose procedure-related risks, they have also been shown to significantly improve symptoms, and even liberate critically ill patients from invasive mechanical ventilation [26,27]. In fact, Ost et al [8] identified that higher-risk patients (those with the highest pre-procedural report of dyspnea and the lowest pre-procedural functional status) had the greatest improvement after therapeutic bronchoscopy for malignant CAO.…”

Improving airway management and tracheostomy care through interprofessional collaboration: aligning timing, technique, and teamwork

“…Many aspects of care modify the relationship between tracheostomy tubes and patient outcomes. At the intersection of interventional pulmonology and critical care is therapeutic bronchoscopy, which can improve pulmonary hygiene, facilitating liberation from the ventilator and improving quality of life ( 30 , 31 ). Effective care requires partnership across all professionals participating in tracheostomy care, and the GTC scaffolds quality improvement efforts on a global scale across institutions, allowing for benchmarking of outcomes.…”