Clinical approach to central airway obstruction in adult patients: Perioperative focus on causes and management including tracheo-bronchial stenting

Journal of Cardiothoracic and Vascular Anesthesia, Год журнала: 2025, Номер unknown

Опубликована: Март 1, 2025

Язык: Английский

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ECMO-assisted bronchoscopic therapy for severe tracheal stenosis: a case report and literature review

BMC Pulmonary Medicine, Год журнала: 2025, Номер 25(1)

Опубликована: Март 31, 2025

Severe tracheal stenosis is a life-threatening condition that often requires immediate intervention. Traditional surgical approaches may be challenging in critically ill patients, and bronchoscopic therapies have emerged as less invasive alternative. However, maintaining adequate oxygenation ventilation during these procedures can challenging, especially patients with near-complete airway obstruction. The manipulation of the already compromised bronchoscopy exacerbate respiratory insufficiency, leading to hypoxemia, hypercapnia, even cardiac arrest. To address challenges, extracorporeal membrane (ECMO) has been increasingly utilized supportive measure high-risk interventions. use ECMO managing severe relatively recent development, growing evidence supporting its role facilitating complex By ensuring hemodynamic stability gas exchange, enables safe effective application techniques who would otherwise deemed unsuitable for such procedures. This approach improve outcomes expand treatment options stenosis. A 49-year-old woman, underwent metal stent placement her upper trachea 24 years ago due tuberculous stenosis, was hospitalized worsening dyspnea. thorough evaluation showed entire section narrowed, smallest diameter measuring approximately 4–5 mm. support inadequate patient's oxygen levels bronchoscopy. We conducted support, significantly alleviating dyspnea symptoms post-treatment. first documented case being alongside narrowing caused by tuberculosis. study described patient experiencing scar tuberculosis, successful included supported ECMO. Our handling this provided crucial insights strategies similar situations future.

Язык: Английский

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Airway Stenting Under Venoarterial Extracorporeal Membrane Oxygenation (V-A ECMO) Support With Multimodal Sedation Including Remimazolam in a Patient With Central Airway Stenosis: A Case Report

Cureus, Год журнала: 2025, Номер unknown

Опубликована: Апрель 23, 2025

Язык: Английский

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Pre‐emptive veno‐arterial ECMO in a giant compressive goiter‐related difficult airway: A case report

Artificial Organs, Год журнала: 2024, Номер 48(6), С. 683 - 685

Опубликована: Фев. 22, 2024

A 64-year-old patient required emergency surgery with high risk of intubation failure, without any possibility to perform neither a direct transtracheal access nor VV-ECMO canulation. The was managed thanks VA-ECMO despite the absence cardiac function impairment. This report describes perioperative challenges and management this unconventional case favorable outcome. Severe tracheal stenoses are rare challenging for anesthesia teams1 due difficult airway management. We present didactic anesthetic severe undiagnosed thyroid mass requiring an dyspnea. woman presented in our tertiary university hospital department dyspnea huge cervical (Figure 1, about 21 × 16 13 cm). She reported goiter growing quickly since 2 weeks, now responsible dysphagia CT scan shown retrosternal extension compression trachea esophagus 2, narrowest part: 4 mm). hospitalized fast surgery. If is well described, current algorithms were inadequate clinical situation failure by cricothyrotomy. Veno-venous extracorporeal membrane oxygenation (V-V ECMO) initially purposed, but jugular considered as unsuitable exerted on internal veins. Therefore, we used femoro-femoral veno-arterial ECMO (V-A ECMO). However, V-A dysfunction involved competition between pump patient's heart. Thus, necessary drugs hemodynamic modulation output prepared (norepinephrine, epinephrine, esmolol). additional equipment add axillary cannula refractory Arlequin syndrome available operating room. Sedation initiated carefully continuous infusion Propofol using target plasma concentration (TPC). After intravenous bolus 2500 UI unfractionated heparin, percutaneous cannulations performed right femoral vessels. Then, started 2.2 L/min/m2 (Maquet® Bioline coated circuit, sweep gas flow: 1.5 L/min, FiO2 = 40%). Continuous heparin delivered at 500 UI/h adapted reach ACT range from 160 180 s. Pulse oximetry continually measured hand. Cerebral NIRS compare two brain hemispheres. Cardiac bypass tolerance regularly evaluated transthoracic echocardiography. stabilization, propofol increased gradually continue remifentanil manage (TPC both). No hypoxemia occurred during procedure, several losses spontaneous breathing. reaching appropriated anesthesia, proceed fibroscopic orotracheal Portex® 6.0. resection decompression trachea, changed breathing tube 7.0 laryngoscopy, while ECMO. weaned difficulty (on-pump duration: 3.5 h) antagonized after withdrawing cannulas (protamine sulfate, 1000 UI). closed arterial ProGlide® (Abbott Vascular) preclosing device transferred intensive care unit (ICU). extubated no first day stay favorable. dysphonia or observed. compressions teams. Several authors have subocclusive airways ECMO,2, 3 prophylaxis4, 5 rescue therapy. Most them V-V ECMO3 because only dysfunction. To knowledge, reporting compressive prophylactic chosen compressed inaccessible venous access, even preference over influenced both lack experience center consideration potential resulting substantial release hormones choice made short half-life molecules increase level sedation keep long possible until adequate control. Indeed, unlike ECMO, challenge sufficient transpulmonary avoid normal (Harlequin syndrome), fact that blood ejected fully functional heart not oxygenated more likely infuse brachiocephalic artery trunk thus arm hemisphere. problematic anticipated increasing flow under control regional bilateral pulse hand, all along on-pump duration. Hemodynamic drugs, including fast-acting betablockers, allowed treat Harlequin decreasing native reduce evolution described impossibility cannulate veins implant evolution. A. Behouche writing—original draft, investigation; Sebestyen writing—review & editing; L. Guillet draft; H. Durand P. Chaffanjon D. Bedague editing, investigation, supervision. None.

Язык: Английский

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Safety and efficacy of airway stent placement following bronchial artery embolization: A retrospective study at a single institute

Respiratory Investigation, Год журнала: 2024, Номер 62(4), С. 640 - 644

Опубликована: Май 14, 2024

Язык: Английский

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Anesthetic Strategies in Critical Tracheal Stenosis: A Case Report on a Novel Extracorporeal Membrane Oxygenation-assisted Stenting Approach

Опубликована: Июнь 19, 2024

Aim and background: Tracheal stenosis, arising from intubation-related trauma, poses challenges in management, particularly during rigid bronchoscopy (RB).This case explores the effective use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) tracheal stent placement for central airway obstruction.Case description: A 44-year-old male chronic obstructive pulmonary disease (COPD) patient with postcardiac arrest presented worsening respiratory symptoms.Diagnosed postintubation stenosis (PITS), initial flexible attempts failed.Rigid stenting was planned.Due to comorbidities, VA-ECMO initiated before procedure.Upon arrival operating room (OR), ECMO under local anesthesia.Cannulation involved a 29 Fr venous cannula 17 arterial cannula.Systemic anticoagulation maintained.Anesthesia induced, intubated 4.5-size bronchoscope.Stenotic segment dilation 12-mm silicone were performed.Postprocedure, gradually weaned, maintained stable hemodynamics.The underwent successful support, resulting improved obstruction resolution.Conclusion: therapeutic strategies, carrying inherent risks.In this case, provided continuous procedure, aligning recent studies favoring its obstruction.The application our supports safety effectiveness.Clinical significance: This underscores utilization managing PITS stenting.The decision employ should involve multidisciplinary approach.Acknowledging potential complications, findings emphasize need further research.Integrating interventions ensures collaborative ensuring optimal outcomes.

Язык: Английский

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Veno-venous extracorporeal membrane oxygenation-assisted treatment of severe airway stenosis due to goiter: Two case reports

Medicine, Год журнала: 2024, Номер 103(36), С. e39506 - e39506

Опубликована: Сен. 6, 2024

Rationale: Extracorporeal membrane oxygenation (ECMO) is a critical care intervention that acts as temporary substitute for the heart and lungs, facilitating adequate tissue perfusion gas exchange. The 2 primary configurations, veno-arterial veno-venous ECMO, are tailored to support either lungs or alone, respectively. Patient concerns: case report details patients with tumor-induced airway stenosis who encountered limitations standard treatments, which were insufficient carried risk of severe complications such hypoxia asphyxia. Diagnoses: Patients diagnosed caused by goiter, condition required innovative treatment approaches prevent during management process. Interventions: Veno-venous ECMO was implemented bridging therapy provide vital respiratory tumor resection procedure. This crucial in reducing risks associated edema rupture. Outcomes: With use successfully underwent resection. They subsequently weaned off support, after course treatment, they discharged good condition. Lessons: demonstrates efficacy managing goiter. Its facilitated successful tumors led positive patient outcomes, highlighting its potential valuable option similar scenarios.

Язык: Английский

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Local Anesthetic Infiltration, Awake Veno-Venous Extracorporeal Membrane Oxygenation, and Airway Management for Resection of a Giant Mediastinal Cyst: A Narrative Review and Case Report

Journal of Clinical Medicine, Год журнала: 2024, Номер 14(1), С. 165 - 165

Опубликована: Дек. 30, 2024

Background: Mediastinal mass syndrome represents a major threat to respiratory and cardiovascular integrity, with difficult evidence-based risk stratification for interdisciplinary management. Methods: We conducted narrative review concerning airway management of patients presenting large mediastinal mass. This is supplemented by case report illustrating our individual approach patient subtotal tracheal stenosis due cyst the thyroid gland. Results: identified numerous grading systems only few reports regional anesthesia techniques extracorporeal membrane oxygenation patients. Clinical Case: After consultation his general physician because exertional dyspnea stridor, 78-year-old no history heart failure was advised present cardiology department under suspicion decompensated failure. Computed tomography imaging showed that most likely originated from left lobe, obstruction trachea. Prior medical included implantation dual-chamber pacemaker complete block in 2022, non-insulin-dependent diabetes mellitus type II, preterminal chronic renal normal diuresis, arterial hypertension, low-grade aortic insufficiency. referral hospital, an including experienced cardiac anesthesiologists, thoracic surgeons, surgeons decided on completing resection via median sternotomy after awake cannulation veno-venous right internal jugular femoral vein anesthesia. An intermediate cervical plexus suprainguinal fascia iliaca compartment were performed, followed induction bronchoscopy-guided placement endotracheal tube over stenosed part The performed minimal blood loss. resection, exit blockade dual chamber prompted emergency surgical revision. explanted operation operating room. postoperative course uneventful, released home stable condition. Conclusions: Awake placed local anesthetic infiltration feasible individualized high collapse, especially if critically alters anatomy. Compressible cysts may represent subgroup easy passage tube. Interdisciplinary collaboration during planning stage essential maximum safety. Prospective data regarding effectiveness needed.

Язык: Английский

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Lung isolation—a personalized and clinically adapted approach to control bronchoscopy-associated acute massive airway hemorrhage

BMC Pulmonary Medicine, Год журнала: 2023, Номер 23(1)

Опубликована: Ноя. 30, 2023

The current concept of bronchoscopy-associated massive airway hemorrhage is not accurate enough, and the amount bleeding as only evaluation criterion cannot comprehensively evaluate magnitude effects severity.To propose acute hemorrhage, analyze its impact on patients highlight treatment approach without ECMO support.A retrospective cohort study.Include all who received bronchoscopy intervention therapy at Interventional Pulmonology Center Emergency General Hospital from 2004 to December 2021.223 met inclusion criteria.Patients were divided into two groups: group (n = 29) non-acute 194).Perioperative adverse events between groups main outcome. Secondary outcome was lung isolation patient in Acute.The incidence 0.11%, 0.76% this study. There significant differences intraoperative hypoxemia, lowest SpO2, hemorrhagic shock, cardiopulmonary resuscitation, mortality, transfer ICU (P<0.05, respectively). Lung used 12 with 2 died during operation.Bronchoscopy-associated had more serious due rapid bleeding, blurred vision bronchoscopy, inability stop quickly, blood filling alveoli, oxygenation lobes. Polyvinyl chloride single-lumen endotracheal intubation for isolation, characteristics low difficulty, wide applicability available most hospitals, may reduce mortality hemorrhage.Chinese Clinical Trial Registry 13/03/2022.ChiCTR2200057470.

Язык: Английский

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