PURPOSE: Airway stents are an efficacious treatment for patients with tracheobronchomalacia (TBM). However, significant complications have been reported related to stent migration and occlusion. We describe the reduction in these complications through the use of standardized protocol with insertion of silicone Y-stents and the use of a combination therapy with a mucolytic and an expectorant.
METHODS: A prospective observational study of patients evaluated for TBM and subsequently treated with silicone airway stenting. Baseline respiratory symptoms, functional status and quality of life measures were assessed. TBM was documented by a dynamic flexible bronchoscopy and a silicone Y stent was placed via rigid bronchoscopy. Following stent placement, patients were managed with combination therapy with an inhaled mucolytic (N-acetylcysteine) and an oral expectorant (Guaifenesin). Complication data were recorded and compared to patients not treated with the standardized protocol.
RESULTS: Of 238 patients evaluated for TBM, 141 were referred for stent placement (59%). 98 patients (69%) were treated following the standardized protocol. Overall complication rates were similar between the two groups (65% vs. 51%; p=0.143) and symptom improvement was unchanged (69% vs. 66%; p=0.846). However, serious complications (stent migration, obstruction, respiratory failure and hemoptysis) were significantly lower in the standardized protocol group (9% vs 40%; p=<0.0001). Obstruction and stent migration were the complications most positively impacted by standardized protocol, whereas secretions and granulation tissue formation were increased.
CONCLUSION: The use of a standardized protocol reduces serious complications by improving stent patency and decreasing stent migration. The increase in secretions appears related to therapeutic thinning of secretions caused by mucolytics. Overall, complications of stents were readily managed and did not impede other aspects of patient care and evaluation.
CLINICAL IMPLICATIONS: The use of a standardized protocol can significantly reduce serious complications of airway stenting in patients with TBM and enhances clinical ability to accurately assess stent response.
DISCLOSURE: David Odell, No Financial Disclosure Information; No Product/Research Disclosure Information