Semin Respir Crit Care Med 2008; 29(4): 441-452
DOI: 10.1055/s-2008-1081286
© Thieme Medical Publishers

Airway Interventions in the Tracheobronchial Tree

Erik Folch1 , Atul C. Mehta1
  • 1Department of Pulmonary, Allergy, and Critical Care Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio
Further Information

Publication History

Publication Date:
23 July 2008 (online)

ABSTRACT

The field of interventional pulmonary medicine is a relatively new area in pulmonary medicine resulting from the technological advances, as well as the increasing need for palliative and curative treatment modalities for patients with tracheobronchial, parenchymal, and pleural disease. This article reviews the advances in endoscopic techniques aimed to the tracheobronchial tree, including foreign body removal, laser photoresection, electrosurgery, argon-plasma coagulation (APC), photodynamic therapy, cryotherapy, balloon bronchoplasty, stent placement, brachytherapy, bronchial thermoplasty, transtracheal oxygen catheter placement, as well as treatment of airway complications after lung transplantation.

REFERENCES

  • 1 Kollofrath O. Entfernung eines Knochenstucks aus dem rechten Bronchus auf naturlichem Wege und unter Anwendung de directen Laryngoscopie.  Munchener Medizinische Wochenschrift. 1897;  38 1038-1039
  • 2 Limper A H, Prakash U B. Tracheobronchial foreign bodies in adults.  Ann Intern Med. 1990;  112 604-609
  • 3 Martinot A, Closset M, Marquette C H et al.. Indications for flexible versus rigid bronchoscopy in children with suspected foreign-body aspiration.  Am J Respir Crit Care Med. 1997;  155 1676-1679
  • 4 Mittleman R E, Wetli C V. The fatal cafe coronary: foreign-body airway obstruction.  JAMA. 1982;  247 1285-1288
  • 5 Diaz-Jimenez J P. Bronchoscopic approach to tracheobronchial foreign bodies in adults pro-rigid bronchoscopy.  Journal of Bronchology. 1997;  4 159-172
  • 6 Mehta A C, Dasgupta A. Bronchoscopic approach to tracheobronchial foreign bodies in adults pro-flexible bronchoscopy.  Journal of Bronchology. 1997;  4 173-178
  • 7 Gibson Jr W S, Vrabec D P. Encounters with challenging bronchial foreign bodies: impromptu adaptation of technique.  Ann Otol Rhinol Laryngol. 2000;  109 86-88
  • 8 Cameron J L, Mitchell W H, Zuidema G D. Aspiration pneumonia: clinical outcome following documented aspiration.  Arch Surg. 1973;  106 49-52
  • 9 Simoff M J, Sterman D H, Ernst A. Thoracic Endoscopy: Advances in Interventional Pulmonology. Malden, MA; Blackwell Futura 2006 xiii, 361 p
  • 10 Van Der Spek A F, Spargo P M, Norton M L. The physics of lasers and implications for their use during airway surgery.  Br J Anaesth. 1988;  60 709-729
  • 11 Tellides G, Ugurlu B S, Kim R W, Hammond G L. Pathogenesis of systemic air embolism during bronchoscopic Nd:YAG laser operations.  , [see comment] Ann Thorac Surg. 1998;  65 930-934
  • 12 Wang K P, Mehta A C, Turner J F. Flexible Bronchoscopy. 2nd ed. Malden, MA; Blackwell 2004 xi, 287 p
  • 13 McDougall J C, Cortese D A. Neodymium-YAG laser therapy of malignant airway obstruction: a preliminary report.  Mayo Clin Proc. 1983;  58 35-39
  • 14 Krawtz S, Mehta A C, Wiedemann H P et al.. Nd-YAG laser–induced endobronchial burn: management and long-term follow-up.  Chest. 1989;  95 916-918
  • 15 Geffin B, Shapshay S M, Bellack G S, Hobin K, Setzer S E. Flammability of endotracheal tubes during Nd-YAG laser application in the airway.  Anesthesiology. 1986;  65 511-515
  • 16 Simpson J I, Wolf G L. Flammability of esophageal stethoscopes, nasogastric tubes, feeding tubes, and nasopharyngeal airways in oxygen- and nitrous oxide-enriched atmospheres.  Anesth Analg. 1988;  67 1093-1095
  • 17 Dumon J F, Shapshay S, Bourcereau J et al.. Principles for safety in application of neodymium-YAG laser in bronchology.  Chest. 1984;  86 163-168
  • 18 Miyazawa T, Miyazu Y, Iwamoto Y et al.. Stenting at the flow-limiting segment in tracheobronchial stenosis due to lung cancer.  Am J Respir Crit Care Med. 2004;  169 1096-1102
  • 19 Shah H, Garbe L, Nussbaum E et al.. Benign tumors of the tracheobronchial tree: endoscopic characteristics and role of laser resection.  Chest. 1995;  107 1744-1751
  • 20 Cavaliere S, Venuta F, Foccoli P, Toninelli C, La Face B. Endoscopic treatment of malignant airway obstructions in 2,008 patients.  Chest. 1996;  110 1536-1542
  • 21 Moghissi K, Dixon K, Hudson E, Stringer M, Brown S. Endoscopic laser therapy in malignant tracheobronchial obstruction using sequential Nd YAG laser and photodynamic therapy.  Thorax. 1997;  52 281-283
  • 22 Chella A, Ambrogi M C, Ribechini A et al.. Combined Nd-YAG laser/HDR brachytherapy versus Nd-YAG laser only in malignant central airway involvement: a prospective randomized study.  Lung Cancer. 2000;  27 169-175
  • 23 Hooper R G, Jackson F N. Endobronchial electrocautery.  Chest. 1985;  87 712-714
  • 24 Caramella J P, Dodinot B. Cardiac pacemaker deprogramming by electrocautery. An update.  Ann Fr Anesth Reanim. 1989;  8 290-292
  • 25 Hooper R G, Jackson F N. Endobronchial electrocautery.  Chest. 1988;  94 595-598
  • 26 Gerasin V A, Shafirovsky B B. Endobronchial electrosurgery.  Chest. 1988;  93 270-274
  • 27 Ledingham S J, Goldstraw P. Diathermy resection and radioactive gold grains for palliation of obstruction due to recurrence of bronchial carcinoma after external irradiation.  Thorax. 1989;  44 48-51
  • 28 Petrou M, Kaplan D, Goldstraw P. Bronchoscopic diathermy resection and stent insertion: a cost effective treatment for tracheobronchial obstruction.  Thorax. 1993;  48 1156-1159
  • 28a Pedersen U, Kristensen S, Ilum P. Palliative resection with high-frequency cutting-loop in malignant tracheobronchial disease.  Journal of Bronchology. 1994;  1 23-25
  • 29 Sutedja G, van Kralingen K, Schramel F M, Postmus P E. Fibreoptic bronchoscopic electrosurgery under local anaesthesia for rapid palliation in patients with central airway malignancies: a preliminary report.  Thorax. 1994;  49 1243-1246
  • 30 Homasson J P, Roden S, Angebault M, Thuy M P, Phuong T N. Treatment of bronchial tumors with high-frequency thermocoagulation: preliminary studies.  Rev Pneumol Clin. 1995;  51 77-81
  • 31 Sutedja T G, van Boxem T J, Schramel F M, van Felius C, Postmus P E. Endobronchial electrocautery is an excellent alternative for Nd:YAG laser to treat airway tumors.  Journal of Bronchology. 1997;  4 101-105
  • 32 Coulter T D, Mehta A C. The heat is on: impact of endobronchial electrosurgery on the need for Nd-YAG laser photoresection.  Chest. 2000;  118 516-521
  • 33 Sheski F D, Mathur P N. Endobronchial electrosurgery: argon plasma coagulation and electrocautery.  Semin Respir Crit Care Med. 2004;  25 367-374
  • 34 Morice R C, Ece T, Ece F, Keus L. Endobronchial argon plasma coagulation for treatment of hemoptysis and neoplastic airway obstruction.  Chest. 2001;  119 781-787
  • 35 Reichle G, Freitag L, Kullmann H J et al.. Argon plasma coagulation in bronchology: a new method–alternative or complementary?.  Pneumologie. 2000;  54 508-516
  • 36 Crosta C, Spaggiari L, De Stefano A et al.. Endoscopic argon plasma coagulation for palliative treatment of malignant airway obstructions: early results in 47 cases.  Lung Cancer. 2001;  33 75-80
  • 37 Colt H G. Bronchoscopic resection of Wallstent-associated granulation tissue using argon plasma coagulation.  Journal of Bronchology. 1998;  5 209-214
  • 38 Utzig M J, Warzelhan J, Wertzel H, Berwanger I, Hasse J. Role of thoracic surgery and interventional bronchoscopy in Wegener's granulomatosis.  Ann Thorac Surg. 2002;  74 1948-1952
  • 39 Bergler W, Honig M, Gotte K, Petroianu G, Hormann K. Treatment of recurrent respiratory papillomatosis with argon plasma coagulation.  J Laryngol Otol. 1997;  111 381-384
  • 40 Iwamoto Y, Miyazawa T, Kurimoto N et al.. Interventional bronchoscopy in the management of airway stenosis due to tracheobronchial tuberculosis.  Chest. 2004;  126 1344-1352
  • 41 Hayata Y, Kato H, Konaka C et al.. Fiberoptic bronchoscopic laser photoradiation for tumor localization in lung cancer.  Chest. 1982;  82 10-14
  • 42 Vergnon J M, Huber R M, Moghissi K. Place of cryotherapy, brachytherapy and photodynamic therapy in therapeutic bronchoscopy of lung cancers.  Eur Respir J. 2006;  28 200-218
  • 43 Bolliger C T, Mathur P N, Beamis J F et al.. ERS/ATS statement on interventional pulmonology. European Respiratory Society/American Thoracic Society.  Eur Respir J. 2002;  19 356-373
  • 44 Moghissi K, Dixon K. Is bronchoscopic photodynamic therapy a therapeutic option in lung cancer?.  Eur Respir J. 2003;  22 535-541
  • 45 Mathur P N, Wolf K M, Busk M F, Briete W M, Datzman M. Fiberoptic bronchoscopic cryotherapy in the management of tracheobronchial obstruction.  Chest. 1996;  110 718-723
  • 46 Fahy G M, Saur J, Williams R J. Physical problems with the vitrification of large biological systems.  Cryobiology. 1990;  27 492-510
  • 47 Gage A A, Caruana Jr J A, Montes M. Critical temperature for skin necrosis in experimental cryosurgery.  Cryobiology. 1982;  19 273-282
  • 48 Gage A A, Guest K, Montes M, Caruana J A, Whalen Jr D A. Effect of varying freezing and thawing rates in experimental cryosurgery.  Cryobiology. 1985;  22 175-182
  • 49 Smith J J, Fraser J. An estimation of tissue damage and thermal history in the cryolesion.  Cryobiology. 1974;  11 139-147
  • 50 Miller R H, Mazur P. Survival of frozen-thawed human red cells as a function of cooling and warming velocities.  Cryobiology. 1976;  13 404-414
  • 51 Bischof J, Christov K, Rubinsky B. A morphological study of cooling rate response in normal and neoplastic human liver tissue: cryosurgical implications.  Cryobiology. 1993;  30 482-492
  • 52 Forest V, Peoc'h M, Campos L, Guyotat D, Vergnon J M. Benefit of a combined treatment of cryotherapy and chemotherapy on tumour growth and late cryo-induced angiogenesis in a non-small-cell lung cancer model.  Lung Cancer. 2006;  54 79-86
  • 53 Forest V, Peoc'h M, Campos L, Guyotat D, Vergnon J M. Effects of cryotherapy or chemotherapy on apoptosis in a non-small-cell lung cancer xenografted into SCID mice.  Cryobiology. 2005;  50 29-37
  • 54 McArdle J R, Gildea T R, Mehta A C. Balloon bronchoplasty: its indications, benefits, and complications.  Journal of Bronchology. 2005;  12 123-127
  • 55 Ferretti G, Jouvan F B, Thony F, Pison C, Coulomb M. Benign noninflammatory bronchial stenosis: treatment with balloon dilation.  Radiology. 1995;  196 831-834
  • 56 Lee K W, Im J G, Han J K et al.. Tuberculous stenosis of the left main bronchus: results of treatment with balloons and metallic stents.  J Vasc Interv Radiol. 1999;  10 352-358
  • 57 Hebra A, Powell D D, Smith C D, Othersen Jr H B. Balloon tracheoplasty in children: results of a 15-year experience.  J Pediatr Surg. 1991;  26 957-961
  • 58 Fouty B W, Pomeranz M, Thigpen T P, Martin R J. Dilatation of bronchial stenoses due to sarcoidosis using a flexible fiberoptic bronchoscope.  Chest. 1994;  106 677-680
  • 59 Sheski F D, Mathur P N. Long-term results of fiberoptic bronchoscopic balloon dilation in the management of benign tracheobronchial stenosis.  Chest. 1998;  114 796-800
  • 60 Nakamura K, Terada N, Ohi M et al.. Tuberculous bronchial stenosis: treatment with balloon bronchoplasty.  AJR Am J Roentgenol. 1991;  157 1187-1188
  • 61 Mehta A C, Lee F Y, Cordasco E M et al.. Concentric tracheal and subglottic stenosis: management using the Nd-YAG laser for mucosal sparing followed by gentle dilatation.  Chest. 1993;  104 673-677
  • 62 Keller C, Frost A. Fiberoptic bronchoplasty: description of a simple adjunct technique for the management of bronchial stenosis following lung transplantation.  Chest. 1992;  102 995-998
  • 63 Jaffe R B. Balloon dilation of congenital and acquired stenosis of the trachea and bronchi.  Radiology. 1997;  203 405-409
  • 64 Fowler C L, Aaland M O, Harris F L. Dilatation of bronchial stenosis with Gruentzig balloon.  J Thorac Cardiovasc Surg. 1987;  93 308-309
  • 65 Carlin B W, Harrell II J H, Moser K M. The treatment of endobronchial stenosis using balloon catheter dilatation.  Chest. 1988;  93 1148-1151
  • 66 Carre P, Rousseau H, Lombart L et al.. Balloon dilatation and self-expanding metal Wallstent insertion: for management of bronchostenosis following lung transplantation. The Toulouse Lung Transplantation Group.  Chest. 1994;  105 343-348
  • 67 De Gracia J, Culebras M, Alvarez A et al.. Bronchoscopic balloon dilatation in the management of bronchial stenosis following lung transplantation.  Respir Med. 2007;  101 27-33
  • 68 Chhajed P N, Malouf M A, Tamm M, Spratt P, Glanville A R. Interventional bronchoscopy for the management of airway complications following lung transplantation.  Chest. 2001;  120 1894-1899
  • 69 Susanto I, Peters J I, Levine S M et al.. Use of balloon-expandable metallic stents in the management of bronchial stenosis and bronchomalacia after lung transplantation.  Chest. 1998;  114 1330-1335
  • 70 Orons P D, Amesur N B, Dauber J H et al.. Balloon dilation and endobronchial stent placement for bronchial strictures after lung transplantation.  J Vasc Interv Radiol. 2000;  11 89-99
  • 71 Bekci T T, Karaagac G, Aydemir C, Karakoca Y. An adenoid cystic carcinoma case treated with resector balloon.  Journal of Bronchology. 2008;  15 64-66
  • 72 Karakoca Y, Karaagac G, Aydemir C. Easy endobronchial resection technique with a new device: P1–014. Journal of Thoracic Oncology 12th World Conference on Lung Cancer, Seoul.  Korea (South). 2007;  2(8, Supplement 4) S555
  • 73 Bolliger C T, Sutedja T G, Strausz J, Freitag L. Therapeutic bronchoscopy with immediate effect: laser, electrocautery, argon plasma coagulation and stents.  , [see comment] Eur Respir J. 2006;  27 1258-1271
  • 74 Lund M E, Garland R, Ernst A. Airway stenting: applications and practice management considerations.  , [see comment] Chest. 2007;  131 579-587
  • 75 Saad C P, Murthy S, Krizmanich G, Mehta A C. Self-expandable metallic airway stents and flexible bronchoscopy: long-term outcomes analysis.  Chest. 2003;  124 1993-1999
  • 76 Lunn W, Feller-Kopman D, Wahidi M et al.. Endoscopic removal of metallic airway stents.  Chest. 2005;  127 2106-2112
  • 77 Noppen M, Stratakos G, Amjadi K et al.. Stenting allows weaning and extubation in ventilator- or tracheostomy dependency secondary to benign airway disease.  Respir Med. 2007;  101 139-145
  • 78 Allen M D, Baldwin J C, Fish V J et al.. Combined laser therapy and endobronchial radiotherapy for unresectable lung carcinoma with bronchial obstruction.  Am J Surg. 1985;  150 71-77
  • 79 Schray M F, McDougall J C, Martinez A, Edmundson G K, Cortese D A. Management of malignant airway obstruction: clinical and dosimetric considerations using an iridium-192 afterloading technique in conjunction with the neodymium-YAG laser.  Int J Radiat Oncol Biol Phys. 1985;  11 403-409
  • 80 Roach III M, Leidholdt Jr E M, Tatera B S, Joseph J. Endobronchial radiation therapy (EBRT) in the management of lung cancer.  Int J Radiat Oncol Biol Phys. 1990;  18 1449-1454
  • 81 Cotter G W, Herbert D E, Ellingwood K E. Inoperable endobronchial obstructing lung carcinoma treated with combined endobronchial and external beam irradiation.  South Med J. 1991;  84 562-565
  • 82 Lo T C, Beamis Jr J F, Weinstein R S et al.. Intraluminal low-dose rate brachytherapy for malignant endobronchial obstruction.  Radiother Oncol. 1992;  23 16-20
  • 83 Mehta M, Petereit D, Chosy L et al.. Sequential comparison of low dose rate and hyperfractionated high dose rate endobronchial radiation for malignant airway occlusion.  Int J Radiat Oncol Biol Phys. 1992;  23 133-139
  • 84 Paradelo J C, Waxman M J, Throne B J, Beller T A, Kopecky W J. Endobronchial irradiation with 192Ir in the treatment of malignant endobronchial obstruction.  Chest. 1992;  102 1072-1074
  • 85 Raju P I, Roy T, McDonald R D et al.. IR-192, low dose rate endobronchial brachytherapy in the treatment of malignant airway obstruction.  Int J Radiat Oncol Biol Phys. 1993;  27 677-680
  • 86 Burt P A, O'Driscoll B R, Notley H M, Barber P V, Stout R. Intraluminal irradiation for the palliation of lung cancer with the high dose rate micro-Selectron.  Thorax. 1990;  45 765-768
  • 87 Delclos M E, Komaki R, Morice R C et al.. Endobronchial brachytherapy with high-dose-rate remote afterloading for recurrent endobronchial lesions.  Radiology. 1996;  201 279-282
  • 88 Bedwinek J, Petty A, Bruton C, Sofield J, Lee L. The use of high dose rate endobronchial brachytherapy to palliate symptomatic endobronchial recurrence of previously irradiated bronchogenic carcinoma.  Int J Radiat Oncol Biol Phys. 1992;  22 23-30
  • 89 Sutedja G, Baris G, van Zandwijk N, Postmus P E. High-dose rate brachytherapy has a curative potential in patients with intraluminal squamous cell lung cancer.  Respiration. 1994;  61 167-168
  • 90 Nori D, Allison R, Kaplan B et al.. High dose-rate intraluminal irradiation in bronchogenic carcinoma: technique and results.  Chest. 1993;  104 1006-1011
  • 91 Tendulkar R D, Fleming P A, Reddy C A et al.. High-dose-rate endobronchial brachytherapy for recurrent airway obstruction from hyperplastic granulation tissue.  Int J Radiat Oncol Biol Phys. 2008;  70 701-706
  • 92 Cox G, Miller J D, McWilliams A, Fitzgerald J M, Lam S. Bronchial thermoplasty for asthma.  Am J Respir Crit Care Med. 2006;  173 965-969
  • 93 Cox G, Thomson N C, Rubin A S et al.. Asthma control during the year after bronchial thermoplasty.  N Engl J Med. 2007;  356 1327-1337
  • 94 Pavord I D, Cox G, Thomson N C et al.. Safety and efficacy of bronchial thermoplasty in symptomatic, severe asthma.  Am J Respir Crit Care Med. 2007;  176 1185-1191
  • 95 Murthy S C, Blackstone E H, Gildea T R et al.. Impact of anastomotic airway complications after lung transplantation.  Ann Thorac Surg. 2007;  84 401-409
  • 96 Mughal M M, Gildea T R, Murthy S et al.. Short-term deployment of self-expanding metallic stents facilitates healing of bronchial dehiscence.  Am J Respir Crit Care Med. 2005;  172 768-771
  • 97 Heimlich H J. Respiratory rehabilitation with transtracheal oxygen system.  Ann Otol Rhinol Laryngol. 1982;  91(6 Pt 1) 643-647
  • 98 Christopher K L, Spofford B T, Brannin P K, Petty T L. Transtracheal oxygen therapy for refractory hypoxemia.  JAMA. 1986;  256 494-497
  • 99 Christopher K L, Spofford B T, Petrun M D et al.. A program for transtracheal oxygen delivery. Assessment of safety and efficacy.  Ann Intern Med. 1987;  107 802-808
  • 100 Kampelmacher M J, Deenstra M, van Kesteren R G et al.. Transtracheal oxygen therapy: an effective and safe alternative to nasal oxygen administration.  Eur Respir J. 1997;  10 828-833

Erik FolchM.D. M.Sc. 

Department of Pulmonary, Allergy, and Critical Care Medicine, The Cleveland Clinic Foundation

9500 Euclid Ave., MC: A90, Cleveland, OH 44195

Email: folche@ccf.org

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