CHEST Guidelines-Management-of-Central-Airway-Obstruction_2024

Management-of-Central-Airway-Obstruction_2024_ches

Pdf Summary

The American College of Chest Physicians provided clinical practice guidelines for managing central airway obstruction (CAO), which threatens both malignant and nonmalignant conditions. Given the variability in clinical approaches due to differences in provider training and resources, this guideline offers evidence-based recommendations following a systematic literature review. A total of 31 studies were analyzed, leading to one good practice statement and 10 graded recommendations, though the overall certainty of evidence was very low.<br /><br />Key recommendations include:<br /><br />1. Comprehensive evaluation for suspected CAO involves detailed history, a CT scan of the chest, and relevant labs (Good Practice Statement).<br />   <br />2. Therapeutic bronchoscopy is suggested for symptomatic CAO as an adjunct to medical and/or radiation therapy (Conditional Recommendation).<br /><br />3. Rigid bronchoscopy is preferred over flexible bronchoscopy for therapeutic interventions (Conditional Recommendation).<br /><br />4. General anesthesia or deep sedation is favored over moderate sedation for bronchoscopic procedures (Conditional Recommendation).<br /><br />5. Either jet ventilation or controlled ventilation is suggested for patients under general anesthesia undergoing rigid bronchoscopy (Conditional Recommendation).<br /><br />6. Tumor or tissue excision is recommended for endobronchial disease to achieve airway patency (Conditional Recommendation).<br /><br />7. Airway dilation is encouraged for nonmalignant CAO with stenosis, either alone or with other therapies (Conditional Recommendation).<br /><br />8. Stent placement should be considered if other treatments fail (Conditional Recommendation).<br /><br />9. Both routine and symptom-driven bronchoscopy after stent placement are options (Conditional Recommendation).<br /><br />10. Local bronchoscopic therapies like photodynamic therapy may be used as part of a treatment plan (Conditional Recommendation).<br /><br />11. Surgical resection or therapeutic bronchoscopy may be considered for nonmalignant CAO, with surgery an option for select malignant cases (Conditional Recommendation).<br /><br />This guideline underscores the need for a multidisciplinary approach and shared decision-making in CAO management, with a call for more high-quality research to better guide future recommendations.

Keywords

central airway obstruction

clinical practice guidelines

therapeutic bronchoscopy

rigid bronchoscopy

general anesthesia

airway dilation

stent placement

multidisciplinary approach

evidence-based recommendations

systematic literature review