Use of combined suspension laryngoscopy and jet ventilation for Y-shaped airway stents delivery

Concomitant Intubation with Minimal Cuffed Tube and Rigid Bronchoscopy for Severe Tracheo-Carinal Obstruction

BACKGROUND

Our aim was to report on the use of an innovative technique for airway management utilizing a small diameter, short-cuffed, long orotracheal tube for assisting operative rigid bronchoscopy in critical airway obstruction.

METHODS

We retrospectively reviewed the clinical data of 36 patients with life-threatening critical airway stenosis submitted for rigid bronchoscopy between January 2008 and July 2021. The supporting ventilatory tube, part of the Translaryngeal Tracheostomy KIT (Fantoni method), was utilized in tandem with the rigid bronchoscope during endoscopic airway reopening.

RESULTS

Indications for collateral intubation were either tumors of the trachea with near-total airway obstruction (13), or tumors of the main carina with total obstruction of one main bronchus and possible contralateral involvement (23). Preliminary dilation was necessary before tube placement in only 2/13 patients with tracheal-obstructing tumors (15.4%). No postoperative complications were reported. There was one case of an intraoperative cuff tear, with no further technical problems.

CONCLUSIONS

In our experience, this innovative method proved to be safe, allowing for continuous airway control. It enabled anesthesia inhalation, use of neuromuscular blockage and reliable end-tidal CO2 monitoring, along with protection of the distal airway from blood flooding. The shorter time of the procedure was due to the lack of need for pauses to ventilate the patient.

Use of a modified endotracheal tube for self-expandable metallic Y-shaped airway stent deployment without rigid bronchoscope or fluoroscopic guidance

Background

Self-expandable metallic Y-shaped airway stents (SEMYS) are commonly used in the management of airway stenosis and fistulae caused by thoracic neoplasms.

Methods

A new technique using a slightly modified regular endotracheal tube has been developed for the deployment of SEMYS with flexible bronchoscopy alone. The technique and devices are described.

Results

To date, successful deployment of SEMYS with this method has been carried out successfully in 17 out of 20 patients without major complications while the other 3 required conversion to rigid bronchoscopy because of limited pharyngeal cavity space, massive hemorrhage and severe cicatrization of the airway, respectively.

Conclusions

This simplified deployment technique with the modified endotracheal tube enables safe, simple and fast insertion of SEMYS in a regular bronchoscopy suite, which may benefit the vast less privileged institutions where SEMYS are necessary but rigid bronchoscopy and fluoroscopy are not available. The skill of the bronchoscopist, cautious selection of patients and effective coordination of the operating team are crucial for the procedure.

Double stent insertion for combined malignant airway and superior vena cava obstruction

The present study sought to assess the feasibility and effectiveness of double stent insertion as a means of managing combined malignant airway and superior vena cava (SVC) obstruction (CMASO).From July 2010 to January 2018, twelve consecutive patients with CMASO were treated by double stent insertion (airway and SVC stents) in our centers. We assessed data pertaining to both technical and clinical success rates, as well as to long-term patient outcomes.The use of double stents (12 airway stents and 19 SVC stents) was technically successful in all study subjects, with a 0 to 92 days period between the 2 stent insertions (mean 27.8 days). Patients did not show evidence of any procedure-related complications. Mean patient Hugh-Jones grades improved from 4.4 ± 0.5 before inserting the airway stent down to 1.2 ± 0.4 following this insertion (P < .001). Mean SVC pressure was reduced from 17.5 ± 2.8 mm Hg before the stent insertion down to 6.7 ± 1.4 mm Hg following this insertion (P < .001). Fifty-six days after insertion, a single patient experienced re-obstruction of their SVC stent. All patients died within the follow-up period, with a median survival time of 113 days for these 12 patients.This double stent insertion protocol is both effective and safe as a means of offering palliative care to those with CMASO.

Temporary tracheal stenting using endovascular prosthesis in the management of severe refractory stenosis following slide tracheoplasty

OBJECTIVES

To evaluate the role of endovascular stents in temporary tracheal stenting and endoscopic treatment strategy for patients with severe refractory tracheal stenosis following slide tracheoplasty.

METHODS

Two patients had severe tracheal stenosis after slide tracheoplasty for long segment congenital tracheal stenosis. Both these patients were managed endoscopically and an endovascular prosthesis was used to temporarily stent the trachea. Short and long term results were evaluated clinically and with repeated endoscopies.

RESULTS

The 2 patients had an excellent recovery immediately after the stent placement and continue to have an optimal, age-appropriate stable tracheal diameter after stent removal.

CONCLUSION

Endovascular stents can be temporarily used to stent the trachea in the endoscopic treatment strategy to correct refractory severe tracheal stenosis following slide tracheoplasty.