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Seminars in Respiratory and Critical... Aug 2022Malignant central airway obstruction (MCAO) is a debilitating and life-limiting complication that occurs in an unfortunately large number of individuals with advanced...
Malignant central airway obstruction (MCAO) is a debilitating and life-limiting complication that occurs in an unfortunately large number of individuals with advanced intrathoracic cancer. Although the management of MCAO is multimodal and interdisciplinary, the task of providing patients with prompt palliation falls increasingly on the shoulders of interventional pulmonologists. While a variety of tools and techniques are available for the management of malignant obstructive lesions, advancements and evolution in this therapeutic venue have been somewhat sluggish and limited when compared with other branches of interventional pulmonary medicine (e.g., the early diagnosis of peripheral lung nodules). Indeed, one pragmatic, albeit somewhat uncharitable, reading of this article's title might suggest a wry smile and shug of the shoulders as to imply that relatively little has changed in recent years. That said, the spectrum of interventions for MCAO continues to expand, even if at a less impressive clip. Herein, we present on MCAO and its endoscopic and nonendoscopic management-that which is old, that which is new, and that which is still on the horizon.
Topics: Airway Obstruction; Bronchoscopy; Humans; Lung Neoplasms; Pulmonary Medicine; Pulmonologists
PubMed: 35654419
DOI: 10.1055/s-0042-1748187 -
Facial Plastic Surgery Clinics of North... Nov 2016This article reviews the presentation of children with craniofacial anomalies by the most common sites of airway obstruction. Major craniofacial anomalies may be... (Review)
Review
This article reviews the presentation of children with craniofacial anomalies by the most common sites of airway obstruction. Major craniofacial anomalies may be categorized into those with midface hypoplasia, mandible hypoplasia, combined midface and mandible hypoplasia, and midline deformities. Algorithms of airway interventions are provided to guide the initial management of these complex patients.
Topics: Airway Management; Airway Obstruction; Bronchoscopy; Craniofacial Abnormalities; Humans; Osteogenesis, Distraction; Polysomnography; Tracheostomy
PubMed: 27712810
DOI: 10.1016/j.fsc.2016.06.002 -
Journal of Cranio-maxillo-facial... Dec 2016There is widespread lack of consensus regarding treatment of airway obstruction in children with Robin Sequence. This study aimed to systematically summarize outcomes of... (Review)
Review
There is widespread lack of consensus regarding treatment of airway obstruction in children with Robin Sequence. This study aimed to systematically summarize outcomes of non-surgical and surgical options to treat airway obstruction in children with Robin Sequence. The authors searched the Medline, EMBASE and CENTRAL databases. Studies primarily on mandibular distraction were excluded. Study quality was appraised with the Methodological Index for Non-Randomized Studies (MINORS) score. Forty-eight studies were included, of which 45 studies had a retrospective non-comparative set up, two studies had a prospective design and one study was a clinical trial. The mean MINORS score was 7.3 (range 3-10). The rates of successful relief of the airway obstruction (SRoAO) were: not available for orthodontic appliance (2 studies, n = 24), 67-100% for nasopharyngeal airway (6 studies, n = 126); 100 % for non-invasive respiratory support (2 studies, n = 12); 70-96% for tongue-lip adhesion (11 studies, n = 277); 50-84% for subperiosteal release of the floor of the mouth (2 studies, n = 47); 100% for mandibular traction (3 studies, n = 133); 100% for tracheostomy (1 study, n = 25). The complication rate ranged from zero to 55%. Although SRoAO rates seemed comparable, high-level evidence remains scarce. Future research should include description of the definition, treatment indication, and objective outcomes.
Topics: Airway Obstruction; Child; Humans; Nasopharynx; Orthodontic Appliances; Pierre Robin Syndrome; Respiration, Artificial; Treatment Outcome
PubMed: 27876376
DOI: 10.1016/j.jcms.2016.06.021 -
European Respiratory Review : An... Mar 2023Endobronchial stenting is an important aspect of the practice of interventional pulmonology. The most common indication for stenting is the management of clinically... (Review)
Review
Endobronchial stenting is an important aspect of the practice of interventional pulmonology. The most common indication for stenting is the management of clinically significant airway stenosis. The list of endobronchial stents available on the market continues to grow. More recently, patient-specific 3D-printed airway stents have been approved for use. Airway stenting should be considered only when all other options have been exhausted. Due to the environment of the airways and the stent-airway wall interactions, stent-related complications are common. Although stents can be placed in various clinical scenarios, they should only be placed in scenarios with proven clinical benefit. The unwarranted placement of a stent can expose the patient to complications with little or no clinical benefit. This article reviews and outlines the key principles of endobronchial stenting and important clinical scenarios in which stenting should be avoided.
Topics: Humans; Bronchoscopy; Stents; Airway Obstruction
PubMed: 36889785
DOI: 10.1183/16000617.0189-2022 -
Paediatric Anaesthesia Mar 2020Interventional procedures in the airway can be performed in interventional radiology suites or the operating room, by radiologists or other specialists. The most common... (Review)
Review
Interventional procedures in the airway can be performed in interventional radiology suites or the operating room, by radiologists or other specialists. The most common therapeutic interventions carried out by radiologists are balloon dilatation, stenting, and the treatment of certain airway fistulas. These operations can be very challenging for anesthetists in terms of planning, airway management, the identification and treatment of procedural complications and postoperative care. In particular, a multidisciplinary approach to decision-making and planning is important to obtain the best results.
Topics: Airway Obstruction; Child; Humans; Radiology, Interventional; Respiratory System
PubMed: 31903683
DOI: 10.1111/pan.13821 -
Archives of Disease in Childhood.... Jun 2015Upper airway obstruction (UAO) in infants and children has a broad spectrum of presentations including benign self-resolving conditions, from mild croup, to critical... (Review)
Review
Upper airway obstruction (UAO) in infants and children has a broad spectrum of presentations including benign self-resolving conditions, from mild croup, to critical life-threatening conditions which, though uncommon now, require prompt recognition and effective multidisciplinary collaborative management to achieve a good outcome. The aim of this article is to highlight the diagnostic and management difficulties in acute UAO in paediatric patients and encourage a problem-solving approach.
Topics: Airway Obstruction; Child; Female; Humans; Infant; Infant, Newborn; Male; Respiratory Sounds
PubMed: 25035313
DOI: 10.1136/archdischild-2013-304604 -
Otolaryngologic Clinics of North America Oct 2019Pediatric obstructive sleep apnea (OSA) affects 2% to 4% of American children, and is associated with metabolic, cardiovascular, and neurocognitive sequelae. The primary... (Review)
Review
Pediatric obstructive sleep apnea (OSA) affects 2% to 4% of American children, and is associated with metabolic, cardiovascular, and neurocognitive sequelae. The primary treatment for pediatric OSA is adenotonsillectomy. Children with obesity, craniofacial syndromes, and severe baseline OSA are at risk for persistent disease. Evaluation of persistent OSA should focus on identifying the causes of upper airway obstruction. Interventions should be tailored to address the patient's symptomatology, sites of obstruction, and preference for surgical versus medical management. Further research is needed to identify management protocols that result in improved outcomes for children with persistent OSA.
Topics: Adenoidectomy; Airway Obstruction; Child; Endoscopy; Humans; Magnetic Resonance Imaging; Polysomnography; Sleep Apnea, Obstructive; Tonsillectomy
PubMed: 31301824
DOI: 10.1016/j.otc.2019.06.004 -
European Journal of Pediatrics Jan 2022Major congenital anomalies are known to play a role in the management and prognosis of airway obstruction. Most studies assess acquired forms of airway obstruction. Data...
Major congenital anomalies are known to play a role in the management and prognosis of airway obstruction. Most studies assess acquired forms of airway obstruction. Data on congenital or otherwise non-acquired forms of airway obstruction is sparse. In this retrospective, single-institution cohort study, we sought to evaluate and compare the patterns of airway obstruction in children with and without major congenital anomalies, and to assess the impact of management and outcome, irrespective of aetiology. Fifty-five patients were included, 23 with and 32 without underlying major congenital anomalies. Multilevel airway obstruction (usually affecting the nasopharynx, oropharynx, and the trachea) was more common in children with congenital anomalies (91% vs. 41%, p < .001). Consequently, these children required more frequent and earlier surgical management, especially tracheostomy and adenotonsillar surgery.Conclusions: Major congenital anomalies are associated with multilevel airway obstruction and poor functional prognosis. A simple clinical definition considering impact of major congenital anomalies on development and growth may help guide management plans following endoscopic evaluation of the entire airway and flanked by multidisciplinary discussions. What is Known: • Children with major comorbidities display increased disease severity and more prevalent multilevel airway obstruction • Previous studies include both children with acquired and non-acquired forms of airway obstruction; therefore, the actual impact major comorbidities in children with non-acquired causes of airway obstruction remain unclear. What is New: • A total of 42% children in this study population had major comorbidities with and impact on growth and/or psychomotor development, with a higher prevalence of multilevel airway obstruction and worse rates of functional improvement/recovery. • Children with major comorbidities require tracheostomy more often and earlier than those without major comorbidities, and remain tracheostomy-dependent for a longer time.
Topics: Airway Obstruction; Child; Cohort Studies; Humans; Infant; Retrospective Studies; Trachea; Tracheostomy
PubMed: 34291330
DOI: 10.1007/s00431-021-04198-6 -
Thoracic Surgery Clinics May 2018Modern thoracic surgery requires knowledge and skill in advanced bronchoscopic techniques. Rigid bronchoscopy remains a workhorse for the management of central airway... (Review)
Review
Modern thoracic surgery requires knowledge and skill in advanced bronchoscopic techniques. Rigid bronchoscopy remains a workhorse for the management of central airway obstruction. Dilation of tracheal strictures is now much simpler with the advent of the balloon dilator, which can be passed through a therapeutic bronchoscope. Numerous adjuncts, such as laser, argon beam coagulation, electrocautery, and cryotherapy, can be used to improve airway patency. There are now numerous stenting options for strictures that require stenting to maintain airway patency.
Topics: Ablation Techniques; Airway Obstruction; Bronchial Diseases; Bronchoscopy; Dilatation; Humans; Stents; Tracheal Diseases
PubMed: 29627058
DOI: 10.1016/j.thorsurg.2018.01.009 -
Clinical Chemistry and Laboratory... Sep 2023Over 3% of asthmatic patients are affected by a particularly severe form of the disease ("severe asthma", SA) which is often refractory to standard treatment. Airway... (Review)
Review
Over 3% of asthmatic patients are affected by a particularly severe form of the disease ("severe asthma", SA) which is often refractory to standard treatment. Airway remodeling (AR), which can be considered a critical characteristic of approximately half of all patients with SA and currently thought to be the main mechanism triggering fixed airway obstruction (FAO), seems to be a key factor affecting a patient's outcome. Despite the collective efforts of internationally renowned experts, to date only a few biomarkers indicative of AR and no recognizable biomarkers of lung parenchymal remodeling have been identified. This work examines the pathogenesis of airway and lung parenchymal remodeling and the serum biomarkers that may be able to identify the severe asthmatic patients who may develop FAO. The study also aims to examine if Krebs von den Lungen-6 (KL-6) could be considered a diagnostic biomarker of lung structural damage in SA.
Topics: Humans; Lung Diseases, Interstitial; Biomarkers; Asthma; Airway Obstruction; Mucin-1
PubMed: 36989607
DOI: 10.1515/cclm-2022-1323