The utility of interventional pulmonary procedures in liberating patients with malignancy-associated central airway obstruction from mechanical ventilation.
OBJECTIVE
Utilization of intensive care services by patients with malignancy has risen during the past several decades. Newer cancer therapies have improved overall survival and outcomes. Patients with respiratory failure from central airway obstruction related to tumor growth were previously viewed as inappropriate candidates for ventilator support. However, an increasing number of reports suggest that interventional pulmonary (IP) procedures may benefit such patients.


METHODS
We reviewed the literature for case reports or case series from the past 20 years regarding the use of IP procedures for the treatment of respiratory failure from malignancy-associated central airway obstruction.


RESULTS
As a whole, IP procedures were greater than 60 % successful in liberating patients from mechanical ventilation. Moreover, IP procedures served to palliate respiratory symptoms, prolong overall survival, allow for additional cancer treatments, and reduce hospitalization costs. Nevertheless, it remains unclear who may benefit the most from these procedures.


CONCLUSIONS
Although data are limited, IP procedures are generally safe and should be considered for appropriate patients with respiratory failure from malignancy-associated central airway obstruction as a potential means of liberation from mechanical ventilation.
Virginia Tech Carilion School of Medicine, Section of Pulmonary, Critical Care, Environmental, and Sleep Medicine, Carilion Clinic, 1906 Belleview Avenue, Roanoke, VA 24014, USA. mbboyd@carilionclinic.org
Michael
M
Boyd
Edmundo
E
Rubio
D000402:Airway Obstruction / Q000191:economics / Q000209:etiology* / Q000601:surgery / Q000628:therapy*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D009362:Neoplasm Metastasis; D009369:Neoplasms / Q000150:complications*; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D012131:Respiratory Insufficiency / Q000191:economics / Q000628:therapy; D015607:Stents / Q000191:economics; D015300:Ventilator Weaning / Q000191:economics / Q000706:statistics & numerical data