CHEST Guidelines-Management of Central Airway Obstruction

Management of Central Airway Obstruction

Pdf Summary

The American College of Chest Physicians published a Clinical Practice Guideline on managing central airway obstruction (CAO), which is often associated with a poor prognosis. Addressing both malignant and nonmalignant disorders, this guideline is based on systematic literature reviews and expert consensus, resulting in one good practice statement and 10 graded recommendations, despite very low overall certainty of evidence.<br /><br />The guideline emphasizes that a multidisciplinary approach and shared decision-making with patients are crucial due to the complexity of CAO. Management options for symptomatic CAO vary and depend on the cause. These include therapeutic bronchoscopy, surgical interventions, and other combined modalities, reflecting a personalized treatment strategy to optimize patient outcomes.<br /><br />Key recommendations include a comprehensive clinical evaluation for suspected CAO, and the use of therapeutic bronchoscopy for patients with symptomatic CAO. The guideline suggests using rigid bronchoscopy over flexible bronchoscopy and prefers general anesthesia/deep sedation to moderate sedation during procedures. Options like jet ventilation might be considered during rigid bronchoscopy with general anesthesia.<br /><br />For endobronchial disease, tumor or tissue excision and/or ablation are advised. In nonmalignant CAO with stenosis, airway dilation can be a standalone or adjunct treatment. Stent placement is recommended when other therapies fail, with periodic bronchoscopy to manage stent-related complications.<br /><br />Options such as open surgical resection or therapeutic bronchoscopy are recommended for nonmalignant CAO, depending on patient specifics and symptomatology. For certain malignant cases, surgical resection or bronchoscopy may be used, especially where surgical candidacy and localized disease are established. While these recommendations provide structured management pathways, they are conditionally graded due to the limited high-quality evidence available, necessitating further research for refinement and validation.

Keywords

central airway obstruction

clinical practice guideline

multidisciplinary approach

therapeutic bronchoscopy

surgical interventions

personalized treatment

rigid bronchoscopy

general anesthesia

stent placement

endobronchial disease