Pulmonary Procedures |

Outcomes of Therapeutic Bronchoscopy in Malignant Central Airway Obstruction With Respiratory Failure Requiring Mechanical Ventilation FREE TO VIEW

Scott Oh, DO; Adnan Majid, MD; Jey Chung, MD; Bryan Husta, MD; Erik Folch, MD
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Beth Israel Deconess Medical Center, Harvard Medical School, Boston, MA

Chest. 2015;148(4_MeetingAbstracts):850A. doi:10.1378/chest.2258946
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SESSION TITLE: Rigid Bronchoscopy

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Symptomatic malignant central airway obstruction (mCAO) has been reported to occur in up to 30% of patients with lung cancer. mCAO complicated by acute ventilator dependent respiratory failure (aVDRF) has been characterized to portend a very poor prognosis. Mortality has been reported to be as high as 83% prompting some providers to advocate for only end-of-life care. Therapeutic bronchoscopy is efficacious in the restoration of airway patency and has been associated with improvements in dyspnea and quality of life. However, there is limited literature on patients with mCAO complicated by aVDRF. Herein we describe our experience with 25 cases between 2004 and 2015, the largest cohort to date.

METHODS: 3,119 bronchoscopic procedures were identified based on CPT codes for therapeutic bronchoscopy then cross referenced with ICD-9 codes for respiratory failure and cancer between 2004 and 2015. 25 cases of mCAO complicated by aVDRF were identified. A retrospective chart review was performed.

RESULTS: Successful restoration of airway patency was achieved in all patients. Successful liberation from mechanical ventilation was achieved in 72% of patients with a median time of 1 day. Median ICU length of stay was 3 days post procedure. A total of 84% survived to hospital discharge. Median hospital stay was 7 days post procedure. Of the patients discharged, 78% were ambulatory and discharged home. One was discharged to a skilled nursing facility and 2 were transferred to long term acute care facilities. Approximately 83% of those who survived received additional cancer specific therapy. Median survival time of those discharged was 164 days (36-682). Non-small cell lung cancer was the most common tumor type (80%). Other tumors included rectal carcinoma, sarcoma, renal cell carcinoma, thyroid carcinoma, and atypical carcinoid. All patients who died during the hospitalization were transitioned to hospice care.

CONCLUSIONS: Multimodality therapeutic bronchoscopy in mCAO complicated by aVDRF is safe and results in successful liberation from mechanical ventilation in the majority of patients. Furthermore, many of those who survive are discharged home and receive further cancer specific therapies.

CLINICAL IMPLICATIONS: Clinical trials of mCAO are challenging due to ethical considerations. Until more definitive data are available, we recommend patients with mCAO complicated by aVDRF undergo aggressive supportive care including mechanical ventilation and palliative therapeutic bronchoscopy.

DISCLOSURE: The following authors have nothing to disclose: Scott Oh, Adnan Majid, Jey Chung, Bryan Husta, Erik Folch

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