Self-Expandable Metallic Airway Stents and Flexible Bronchoscopy *

A mail survey of this type has several inherent drawbacks. First, answers to some of the questions, particularly those pertaining to complication rates, rely on the memory of participants. Second, the wording of certain questions may have imparted different meanings. Third, the format of the questionnaire may have confused some. Fourth, one cannot expect that all questionnaires will be answered fully. Fifth, as indicated by several respondents, several important topics (eg, topical anesthetic agents and mode of their delivery, prophylaxis against infective endocarditis, tracheobronchial stent placement, endobronchial intraluminal radiotherapy) were not included. Many respondents suggested inclusion of these and other questions in future surveys. Nevertheless, in the absence of any survey looking into a large number of bronchoscopy-related practices, mail surveys have the advantage of reflecting nationwide practice rather than results from selected centers, and this report provides some insight into bronchoscopy practices in North America. While the results indicate the present trends in bronchoscopy practices in North America, they do not establish or recommend any standards in bronchoscopy.

Airway complications are a significant cause of morbidity after lung transplantation. Effective treatment reduces the impact of these complications. Data from 123 lung (99 single, 24 bilateral) transplants were reviewed. Potential risk factors for airway complications were analyzed. Stenoses were treated with expanding metal (Gianturco) stents. Mean follow-up was 749 days. Thirty-five complications developed in 28 recipients (complication rate: 23.8%/anastomosis). Mean time to diagnosis was 47 days. Only Aspergillus infection and airway necrosis were significantly associated with development of complications (p < 0.00001 and p < 0.03, respectively). Stenosis was diagnosed an average of 42 days posttransplant. Average decline in forced expiratory volume in 1 second (FEV1) was 39%. Eighteen patients (13 single and 5 bilateral) required stent insertion. Mean increase in FEV1 poststenting was 87%. Two stent patients died from infectious complications. Six patients required further intervention. Long-term survival and FEV1 did not differ from nonstented patients. Aspergillus and airway necrosis are associated with the development of airway complications. Expanding metal stents are an effective long-term treatment.

Airway stenting (AS) is increasingly used in the management of obstructive lesions of the central airways. Although retention of secretions and infection have been reported as complications of AS, the microbiological consequences of AS have not yet been evaluated. In this study, we prospectively performed protected specimen brush (PSB) sampling of the airways, before and 3 to 4 wk after AS, in 14 consecutive patients (65 +/- 17 yr), suffering from bronchial (5), extensive esophageal (2), thyroid (1), and adenocystic (1) carcinoma, stenotic tracheal burn lesions (2), postintubation stenosis (2), and Wegener's granulomatosis (1). A cutoff value of >/= 10(2) colony-forming units (cfu). ml(-)(1) was considered diagnostic for airway colonization (AC). PSB results were related to the presence and degree of secretion retention (SR) at the level of the stent. In five of the 14 patients, AC was present prior to AS; in three of these, potentially pathogenic microorganisms (PPM) were identified. After AS, AC was found in 11 (including seven patients without prior AC) of the 14 patients. In six of these patients, one or more PPM were present (Pseudomonas aeruginosa [4], Staphylococcus aureus [3], Streptococcus pneumoniae [1], Klebsiella spp. [1]). Although AC tended to be associated with the presence of SR (PSB >/= 10(2) cfu. ml(-)(1) in 10 of 12 SR-positive and in zero SR-negative cases; PSB < 10(2) cfu. ml(-)(1) in two SR-positive and in two SR-negative cases), statistical significance was not reached (Fisher exact test, p = 0.06). We conclude that AS is frequently followed by AC, the majority of which occurs in patients without AC prior to AS, and is caused by PPM. In no case, however, AC was associated with clinical signs of infection. AC tended to be associated with SR in the stent.