SESSION TYPE: Bronchoscopy and Interventional Procedures Posters
PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM
PURPOSE: Life-threatening airway obstruction is a dreaded complication of mediastinal masses. The acute management is difficult and catastrophic outcomes have been reported. The experience in a Medical Intensive Care Unit (ICU) and the management options are discussed.
METHODS: This is a retrospective observational study in the ICU of a 1,600-bed tertiary-care hospital between January 1996 and February 20010. Patients mechanically ventilated due to mediastinal masses and underwent intervention for the critical central airway obstruction were included.
RESULTS: Thirteen patients with median age of 51 years (range 13 to 64) were studied. In 5 patients (36%), the diagnosis was only made after ICU admission. Two had benign pathologies (retrosternal goitre and bronchogenic cyst) and 3 had lymphoma. The remaining 8 had metastatic mediastinal lymphadenopathy. Three received emergent chemotherapy, 10 underwent airway stenting and 2 underwent surgery. All were successfully weaned off the ventilator (range 0 to 5 days). All patients with benign pathologies and lymphoma were still alive with a mean follow-up of 2.8 years (range 1 to 7 years). All patients with metastatic disease died, with a mean survival of 3.8 months (range 1 to 9 months).
CONCLUSIONS: In the management of life-threatening airway obstruction by mediastinal masses, the heterogeneous nature of this group of conditions was illustrated here. Therefore in the intensive care setting, a definitive diagnosis needs to be established urgently, as treatment and prognosis are highly dependent on the underlying etiology.
CLINICAL IMPLICATIONS: In the management of life-threatening airway obstruction by mediastinal masses, categorising patients into subgroups and combining various therapeutic modalities can led to gratifying liberation of these patients from mechanical ventilation.
DISCLOSURE: The following authors have nothing to disclose: Anne Hsu
No Product/Research Disclosure InformationSingapore General Hospital, Singapore, Singapore