title: Bronchoscopic intervention obviates the need for continued mechanical ventilation in patients with airway obstruction and respiratory failure from inoperable non-small-cell lung cancer.
abstract: BACKGROUND
  Patients with advanced non-small-cell lung cancer (NSCLC) and acute respiratory failure (ARF) from central airway obstruction (CAO) may be offered end-of-life care rather than intensive care treatment and palliative bronchoscopic intervention.
  
  
  OBJECTIVE
  To determine whether bronchoscopic intervention could be immediately successful in restoring airway patency and obviate the need for continued mechanical ventilation in a homogeneous group of inoperable mechanically ventilated patients with ARF and CAO from NSCLC.
  
  
  METHODS
  A retrospective study of 12 consecutive intubated and mechanically ventilated patients with inoperable or unresectable CAO from NSCLC referred for therapeutic bronchoscopic intervention between January 2003 and December 2008. Outcome measures included time-to-postintervention extubation and survival. Procedural success was defined as successful restoration of airway patency, extubation and removal from mechanical ventilation within 24 h after bronchoscopic intervention.
  
  
  RESULTS
  Twelve intubated and mechanically ventilated patients were admitted to the ICU during the 6-year study period. Airway patency was restored in 11/12 (91%) patients. Bronchoscopic intervention resulted in immediate extubation and discontinuation of mechanical ventilation in 9/12 (75%) patients. Overall median survival was 228 days (range 6-927). For the 9 patients extubated within 24 h after intervention, however, median survival was 313 days (range 6-927).
  
  
  CONCLUSIONS
  Intubated patients with respiratory failure caused by CAO from NSCLC can be successfully and rapidly removed from mechanical ventilation after bronchoscopic interventions aimed at restoring airway patency. Median survival greater than 10 months justifies ICU hospitalization and referral for bronchoscopic treatment.
authors: University of California, Irvine, Irvine, Calif., USA. smurgu@uci.edu
authors: Septimiu
authors: S
authors: Murgu
authors: Stephanie
authors: S
authors: Langer
authors: Henri
authors: H
authors: Colt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D060666:Airway Extubation / Q000706:statistics & numerical data; D000402:Airway Obstruction / Q000209:etiology / Q000601:surgery*; D001999:Bronchoscopy / Q000379:methods*; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome; D015300:Ventilator Weaning / Q000706:statistics & numerical data