Metallic Stent and Flexible Bronchoscopy without Fluoroscopy for Acute Respiratory Failure

¹ Dept of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taipei, Taiwan

^* To whom correspondence should be addressed. E-mail: q8828{at}ms11.hinet.net.

	Abstract

Stent implantation has been reported to facilitate liberation from mechanical ventilation in patients with respiratory failure due to central airway disease. This retrospective cohort study sought to evaluate the risk and benefit of stent implantation via bronchoscopy without fluoroscopic guidance in mechanically ventilated patients.

From July 2001 to September 2006, 26 patients with acute respiratory failure were recruited for this study. A bronchoscope was inserted through mouth guard into the space between tracheal wall and endotracheal tube. A guidewire was inserted via the flexible bronchoscope to the lesion site. The bronchoscope was reintroduced through the endotracheal tube. Under bronchoscopic visualization, the delivery catheter was advanced over the guidewire to deploy the stent.

These procedures were successfully performed in 26 patients, with 22 stents placed in the trachea and 7 in the main bronchus. Fourteen (53.8%) of the 26 patients became ventilator independent during their ICU stay. Severe pneumonia (7 [58.3%] of 12 patients) was the most common cause for continued ventilator dependence after stenting. Granulation tissue formation was found in seven patients during the follow-up periods.

It is concluded that metallic stents can be safely implanted without fluoroscopic guidance in respiratory failure patients to facilitate ventilator independence.