Rigid Bronchoscopy

Rigid Bronchoscopy

The Art of Rigid Bronchoscopy and Airway Stenting

https://www.ncbi.nlm.nih.gov/pubmed/29433711

Review

Reference: Flannery A, Daneshvar C, Dutau H, Breen D. The Art of Rigid Bronchoscopy and Airway Stenting. Clin Chest Med. 2018;39(1):149-167.

Summary: IP is an essential component of thoracic oncology care. Rigid bronchoscopy and airway stenting offer distinct therapeutic advantages but must be carefully applied to select patients with benign and malignant airway disease.


 Indications and complications of rigid bronchoscopy

https://www.ncbi.nlm.nih.gov/pubmed/29727208

Review

Reference: Batra H, Yarmus L. Indications and complications of rigid bronchoscopy. Expert Rev Respir Med. 2018;12(6):509-520.

Summary: Rigid bronchoscopy provides ability for large volume suction, better airway control, accurate placement of a wide variety of stents. The availability of different lengths, sizes and various tools makes this ideal for dealing with serious conditions such as central airway obstruction (CAO), foreign body removal and massive hemoptysis. Complications are minimal with well-trained operators.


 Rigid Bronchoscopy

https://www.ncbi.nlm.nih.gov/pubmed/30641585

Review

Reference: Diaz-Mendoza J, Peralta AR, Debiane L, Simoff MJ. Rigid Bronchoscopy. Semin Respir Crit Care Med. 2018;39(6):674-684.

Summary: Rigid bronchoscopy is an old technique that has gained importance with the growth of interventional pulmonology. Proper training with solid understanding of equipment, indications, anesthesia and intubation techniques, contraindications and complications are necessary. Standardization of practice is carried out through formal IP training programs. Accreditation exams help maintain academic standards.


 Rigid bronchoscopy and silicone stents in the management of central airway obstruction

https://www.ncbi.nlm.nih.gov/pubmed/26807283

Review

Reference: Semaan R, Yarmus L. Rigid bronchoscopy and silicone stents in the management of central airway obstruction. J Thorac Dis. 2015;7(Suppl 4):S352-62.

Summary: Rigid bronchoscopy is an invaluable tool for diagnosis and management of malignant and non-malignant CAO, including deployment of silicone stents. Various types of silicone stents are available and indications, deployment techniques and complications need to be well understood.


 Evaluation of Safety and Short-term Outcomes of Therapeutic Rigid Bronchoscopy Using Total Intravenous Anesthesia and Spontaneous Assisted Ventilation

https://www.ncbi.nlm.nih.gov/pubmed/31851991

Retrospective 

Reference: Murgu S, Laxmanan B, Stoy S, et al. Evaluation of Safety and Short-term Outcomes of Therapeutic Rigid Bronchoscopy Using Total Intravenous Anesthesia and Spontaneous Assisted Ventilation. Respiration. 2020;99(3):239-247.

Background: The optimal anesthesia and ventilation strategy for rigid bronchoscopy is unknown.

PICO:

Populations:

  • Patients (n=55) with CAO, significant comorbidities, and high ASA class, undergoing therapeutic rigid bronchoscopy (79 procedures) at the University of Chicago between Oct 2012 and Dec 2014

Intervention:

  • Rigid bronchoscopy with total intravenous anesthesia and spontaneous assisted ventilation

Comparison:

  • None

Outcome:

  • Majority (76%) of patients did not require neuromuscular blockade. Complications included intraoperative hypoxemia and hypotension. No intraoperative mortality. 30-day mortality can be limited by shortened operative time.

Take Home: Therapeutic rigid bronchoscopy can be safely performed with total intravenous anesthesia and spontaneous assisted ventilation in high risk patients.


 Complications Following Therapeutic Bronchoscopy for Malignant Central Airway Obstruction: Results of the AQuIRE Registry

https://pubmed.ncbi.nlm.nih.gov/25741903/

Clinical Trial 

Reference: Ost DE, Ernst A, Grosu HB, et al. Therapeutic bronchoscopy for malignant central airway obstruction: success rates and impact on dyspnea and quality of life. Chest. 2015;147(5):1282-1298.

Background: There is limited data on how therapeutic bronchoscopy practice variation affects effectiveness of procedures.

PICO:

Populations:

  • 947 patients with malignant central airway obstruction underwent 1,115 procedures as reported in a multicenter registry

Intervention:

  • Therapeutic flexible or rigid bronchoscopy

Comparison:

  • None

Outcome:

  • There are high technical success rates (90-98%) defined as post procedure airway diameter > 50%, however with limited clinical improvement seen based on dyspnea (48%) and QOL (42%) measures. No statistically significant difference in outcomes between flexible and rigid bronchoscopy procedures.

Take Home: Patients with severe dyspnea and lowest functional status, regardless of clinical risk, benefitted the most from therapeutic bronchoscopy. No difference in effectiveness between flexible vs rigid bronchoscopy.