Large Airway Disorders Flashcards
Pathophys of tracheobronchomalasia
softening of cartilages of the trachea
Excessive Dynamic Airway Collapse (EDAC) pathophysiology
excessive laxity of posterior membranous wall with intact integrity of cartilaginous support
Workup of tracheobronchomalacia (TBM) vs. EDAC
Dynamic CT (very sensitive but patient effort dependent) (at least 90% or more)
Bronchoscopy under moderate sedation so they can do maneuvers
PFTs are NOT specific nor sensitive:
- typical notching of FV loop, biphasic FV loop
Causes of diffuse EDAC
relapsing polychondritis
GERD
recurrent infections
inhalation of chemical irritants
chronic inhaled corticosteroids
Congenital etiology of EDAC
Mounier-Kuhn’s syndrome
Ehlers-Danlos’ syndrome
Normal amount of collapse in central airway in general population
50%
Treatment of TBM and EDAC
treat comorbids
Antibiotics
Airway clearing devices
CPAP, may need during the day too
When is stenting indicated in TBM or EDAC
“Trial” to judge potential response to tracheoplasty - 2 weeksT
Tracheobronchoplasty benefit and risks
mesh placed in airway to fix posterior wall
improves QOL
47% morbidity
30-d mortality of 1%
Etiologies of tracheal stenosis
Benign:
Prolonged intubation and tracheostomy
Relapsing polychondritis
GPA
Sarcoid
Infection
Malignancy
PFTs in tracheal stenosis
only abnormal if it is less than 8 mm
look to see which loop is affected
Inspiratory loop : extrathoracic, variable
Expiratory loop: intrathoracic, variable
Both loops: fixed obstruction
When are patients good candidates for SURGICAL resection for tracheal stenosis
> 2 cm from vocal cords
Length of stenosis <4-5 cm
Outcome of bronchoscopic debulking of malignant tumors
Helps with de-escalation of care (discontinue mechanical ventilation)
NO survival improvement
Imaging for aspirated objects
CT > CXR sensitivity
+ hyperinflation from check valve mechanism
How to remove foreign objects
Most need rigid bronchoscopy for larger objects
Some can be removed with flex
