Procedures: Procedures 1 - EMN/BT/Rigid/Cryo |

Therapeutic Bronchoscopy in Multimodal Therapy for the Management of Central Airway Obstruction: Experience in Fundación Valle del Lili; a Reference Hospital in Latin America FREE TO VIEW

Liliana Fernandez; Luz Sua, PhD; Mauricio Velasquez, MD; Leidys Gutierrez, MD
Author and Funding Information

Fundacion Valle del Lili, Chest Biomedical Research, School of Health Sciences, Universidad Icesi, Cali, Colombia

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):1010A. doi:10.1016/j.chest.2016.08.1116
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SESSION TITLE: Procedures 1 - EMN/BT/Rigid/Cryo

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: Central airway obstruction may be due to malignant and non-malignant causes. The most common is lung cancer. Usually, patients present with cough and dyspnea that can progress to respiratory failure. Therapy should be oriented to secure and restore the airway. Best technique choice depends on etiology, type and severity of lesion, technological availability and operator skill. Nowadays, a multimodal therapy is implemented, including different intervention methods for the management of these patients. We aimed to describe the experience with therapeutic flexible bronchoscopy in FVL.

METHODS: A descriptive retrospective study was conducted between Feb-2013 and Dec-2015. 70 procedures were performed in 62 patients. Symptoms, etiology, localization, severity, diagnosis, type of anesthesia, interventions and complications were analyzed. The device was a therapeutic flexible bronchoscope Olympus and specific intervention instruments.

RESULTS: Patients’ mean age was 53.4(19-88) years old. 25(35.7%) were women and 45(64.2%) were men. Malignant lesions were found in 46 (65.7%) cases. More frequent symptoms were cough (95%), dyspnea (70%), chest pain (34.2%) and hemoptysis (31.4%). General anesthesia was used in 67(95.7%) cases: 37(55,2%) laryngeal mask and 30(44,7%) endotracheal tube. 70% patients had severe airway obstruction and 30% moderate. 84.5% had an endobronchial mass and 35.7% external compression. Decreasing frequency of lesion location was: right-stem bronchi (38.5%), trachea (35.7%), left-stem bronqui (31,4%) and carina (17.1%). Most common malignant etiology was lung cancer (58.6%), followed by carcinoid tumor (13%) and sarcoma (10.8%). Benign etiology (34.8%) included granuloma (33%), stenosis (29,1%) and foreign bodies (20.8%). Procedures were debridement (82.8%), electrocoagulation (81.4%), argon plasma (41.4%), stent colocation (7.1%), balloon dilatation (8.67%) and since Oct-2015 cryoprobe for airway recanalization (11.4%). Obstruction resolution was complete for 58.7% cases and partial for 41.4%. Complications included mild hemoptysis in one case and scaling in the attention room in two patients. No reported deaths associated with the procedure.

CONCLUSIONS: Central airway obstruction is a complex situation that requires multidisciplinary approach. Currently, multimodal therapy is recommended combining different options of intervention, like flexible or rigid bronchoscopy, to achieve optimal results. We presented our experience in multimodal therapy using therapeutic flexible bronchoscopy.

CLINICAL IMPLICATIONS: Flexible bronchoscopy is a promising safe technique that can be offered to patients within multimodal therapy for the optimal management of central airway obstruction, particularly, if we consider the life-threatening potential of this condition and the optimal and prompt management demanded.

DISCLOSURE: The following authors have nothing to disclose: Liliana Fernandez, Luz Sua, Mauricio Velasquez, Leidys Gutierrez

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