Abstract：
BACKGROUND: Central airway obstruction (CAO), seen in a variety of malignant and non-malignant airway disorders, is associated with a poor prognosis. The management of CAO is dependent on provider training and local resources, which may make the clinical approach and outcomes highly variable. We reviewed the current literature and provided evidence-based recommendations for the management of CAO.
METHODS: A multidisciplinary expert panel developed key questions using the PICO (Patient, Intervention, Comparator, and Outcomes) format and conducted a systematic literature search using MEDLINE (PubMed) and the Cochrane Library. The panel screened references for inclusion and used vetted evaluation tools to assess the quality of included studies and extract data, and graded the level of evidence supporting each recommendation. A modified Delphi technique was used to reach consensus on recommendations.
RESULTS: A total of 9,688 abstracts were reviewed, 150 full-text articles were assessed, and 31 studies were included in the analysis. One good practice statement and 10 graded recommendations were developed. The overall certainty of evidence was very low.
CONCLUSIONS: Therapeutic bronchoscopy can improve the symptoms, quality of life, and survival of patients with malignant and non-malignant CAO. Multi-modality therapeutic options, including rigid bronchoscopy with general anesthesia, tumor/tissue debridement, ablation, dilation, and stent placement, should be utilized when appropriate. Therapeutic options and outcomes are dependent on the underlying etiology of CAO. A multidisciplinary approach and shared decision-making with the patient are strongly encouraged.
METHODS: A multidisciplinary expert panel developed key questions using the PICO (Patient, Intervention, Comparator, and Outcomes) format and conducted a systematic literature search using MEDLINE (PubMed) and the Cochrane Library. The panel screened references for inclusion and used vetted evaluation tools to assess the quality of included studies and extract data, and graded the level of evidence supporting each recommendation. A modified Delphi technique was used to reach consensus on recommendations.
RESULTS: A total of 9,688 abstracts were reviewed, 150 full-text articles were assessed, and 31 studies were included in the analysis. One good practice statement and 10 graded recommendations were developed. The overall certainty of evidence was very low.
CONCLUSIONS: Therapeutic bronchoscopy can improve the symptoms, quality of life, and survival of patients with malignant and non-malignant CAO. Multi-modality therapeutic options, including rigid bronchoscopy with general anesthesia, tumor/tissue debridement, ablation, dilation, and stent placement, should be utilized when appropriate. Therapeutic options and outcomes are dependent on the underlying etiology of CAO. A multidisciplinary approach and shared decision-making with the patient are strongly encouraged.
摘要：
背景：中央气道阻塞（CAO），见于各种恶性和非恶性气道疾病，与预后不良有关。CAO的管理依赖于提供商的培训和当地资源，这可能使临床方法和结果高度可变。我们回顾了当前的文献，并为CAO的管理提供了基于证据的建议。
方法：一个多学科专家小组使用PICO（患者，干预,比较器,和结果）格式，并使用MEDLINE（PubMed）和Cochrane图书馆进行了系统的文献检索。小组筛选了纳入的参考文献，并使用经过审查的评估工具来评估纳入研究的质量并提取数据，并对支持每个建议的证据水平进行分级。使用改进的Delphi技术就建议达成共识。
结果：九千，审查了68份摘要，评估了150篇全文，31项研究纳入分析.编写了一份良好做法说明和十项分级建议。证据的总体确定性很低。
结论：支气管镜治疗可以改善症状，生活质量,恶性和非恶性CAO患者的生存率。多模式治疗选择，包括全身麻醉的硬支气管镜检查，肿瘤/组织清创术，消融,膨胀,和支架放置应在适当的时候使用。治疗选择和结果取决于CAO的潜在病因。强烈鼓励多学科方法和与患者共同决策。
方法：一个多学科专家小组使用PICO（患者，干预,比较器,和结果）格式，并使用MEDLINE（PubMed）和Cochrane图书馆进行了系统的文献检索。小组筛选了纳入的参考文献，并使用经过审查的评估工具来评估纳入研究的质量并提取数据，并对支持每个建议的证据水平进行分级。使用改进的Delphi技术就建议达成共识。
结果：九千，审查了68份摘要，评估了150篇全文，31项研究纳入分析.编写了一份良好做法说明和十项分级建议。证据的总体确定性很低。
结论：支气管镜治疗可以改善症状，生活质量,恶性和非恶性CAO患者的生存率。多模式治疗选择，包括全身麻醉的硬支气管镜检查，肿瘤/组织清创术，消融,膨胀,和支架放置应在适当的时候使用。治疗选择和结果取决于CAO的潜在病因。强烈鼓励多学科方法和与患者共同决策。
