title: Neoplastic severe central airways obstruction, interventional bronchoscopy: a decision-making analysis.
abstract: OBJECTIVE
  Cancer can involve the airways, causing various degrees of obstruction. Usually, after days or months of mild to moderate undervalued symptoms, severe dyspnea arises abruptly, imposing an immediate attempt to restore the airflow regardless of the etiology. This study focuses on the development of a predictive preintervention model that is useful when deciding whether to perform therapeutic interventional bronchoscopy in patients with severe central airway obstruction.
  
  
  METHODS
  A total of 804 patients who underwent rigid bronchoscopy under general anesthesia to treat severe neoplastic central airway obstruction from 1990 to 2009 were studied. Electronic records for patients who underwent bronchoscopy were analyzed. The patients were primarily male (n = 618, 76.9%) and the median age was 62 years. Lung cancer was the most frequent cause of neoplastic airway obstruction (n = 645, 81.65%). An estimate of the probability of individual endoscopic success was made.
  
  
  RESULTS
  Of the 804 patients with severe neoplastic airway obstruction, 681 (84.7%) achieved luminal clearance, and the procedure was considered an endoscopic success. Tracheal involvement (rate ratio, 1.21; range, 1.16-1.27) endoluminal mass (rate ratio, 1.13; range, 1.06-1.12), and extrinsic compression (rate ratio, 1.17; 1.11-1.17) were associated significantly with a favorable endoscopic outcome. Tumor location and any kind of mucosal infiltration were the main determinants of the predictive preoperative model of intervention success.
  
  
  CONCLUSIONS
  Endoscopic characteristics and location of the neoplastic lesions are the major determinants of patients' endoscopic outcome. The preintervention model adds to the clinical evaluation an important contribution to the decision-making process on performing therapeutic interventional bronchoscopy in a critical setting.
authors.affiliation: Pulmonary Service, Hospital S. João Medical Center, Porto, Portugal; University of Oporto Medical School, Porto, Portugal. Electronic address: vhespanhol@netcabo.pt.
authors.forename: Venceslau
authors.initials: V
authors.lastname: Hespanhol
authors.affiliation: Pulmonary Service, Hospital S. João Medical Center, Porto, Portugal.
authors.forename: Adriana
authors.initials: A
authors.lastname: Magalhães
authors.affiliation: Pulmonary Service, Hospital S. João Medical Center, Porto, Portugal; University of Oporto Medical School, Porto, Portugal.
authors.forename: Agostinho
authors.initials: A
authors.lastname: Marques
mesh_terms: D000402:Airway Obstruction / Q000209:etiology / Q000601:surgery*; D001999:Bronchoscopy; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012142:Respiratory Tract Neoplasms / Q000150:complications; D012189:Retrospective Studies; D012720:Severity of Illness Index