The following is a summary of “Airway stenting for liberation from positive pressure ventilation in patients with central airway obstruction presenting with acute respiratory failure,” published in the April 2024 issue of Pulmonology by Salguero et al.
Central airway obstruction (CAO) poses a critical risk of acute respiratory failure (RF), often necessitating positive pressure ventilation (PPV) for patient management. However, the utilization of airway stenting to facilitate liberation from PPV in severe acute RF cases still needs to be studied. To address this gap, researchers systematically reviewed PubMed and supplemented their findings with a retrospective analysis of cases encountered at the institutions between 2018 and 2022.
Their systematic review identified fifteen relevant studies comprising 6 patients, revealing a weighted mean success rate of 84.5% for liberation from PPV post-stenting, with a median survival of 127.9 days. In the retrospective series involving 24 patients, malignant CAO was the predominant etiology (83%), and various modes of PPV, including high-flow nasal cannula (HFNC), non-invasive ventilation (NIV), and invasive mechanical ventilation, were employed. Overall, successful liberation from PPV was achieved in 79% of cases, with immediate post-procedure liberation observed in 55% of HFNC and NIV cases. Among patients with successfully liberated malignant CAO, the median survival was 74 days, contrasting with 22 days for those who failed liberation attempts.
Their findings underscore the potential of airway stenting to effectively liberate patients from PPV, facilitating access to pathology-directed treatments and enhancing end-of-life care options in this challenging clinical scenario.
Source: sciencedirect.com/science/article/abs/pii/S0954611124000738