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.

OBJECTIVE: To outline an expert-based consensus of recommendations for the diagnosis and management of pediatric patients with congenital tracheal stenosis.
METHODS: Expert opinions were sought from members of the International Pediatric Otolaryngology Group (IPOG) via completion of an 18-item survey utilizing an iterative Delphi method and review of the literature.
RESULTS: Forty-three members completed the survey providing recommendations regarding the initial history, clinical evaluation, diagnostic evaluation, temporizing measures, definitive repair, and post-repair care of children with congenital tracheal stenosis.
CONCLUSIONS: These recommendations are intended to be used to support clinical decision-making regarding the evaluation and management of children with congenital tracheal stenosis. Responses highlight the diverse management strategies and the importance of a multidisciplinary approach to care of these patients.

OBJECTIVE: The management of laryngotracheal stenosis is challenging, as patients usually require in-time interventions. The current coronavirus disease 2019 (COVID-19) pandemic has added unique challenges to this procedure. The presence of the virus in high concentrations in the aerodigestive tract and the need for an open airway during surgery can increase the risk of aerosolization of the virus and subsequent infection of the surgical, anesthetic, and operating room (OR) personnel.
METHODS: Retrospective cohort study.
METHODS: University hospital.
METHODS: Patients who underwent airway interventions between March and October 2020.
METHODS: A protocolized strategy was initiated during the COVID-19 pandemic to facilitate the consistent management of all patients undergoing airway interventions.
RESULTS: During a seven-month period, 34 patients were managed with this policy. All threatened airways were managed successfully and no healthcare workers dealing with such procedures were infected. Priorities during the current novel coronavirus pandemic are ensuring the safety of healthcare professionals and offering urgent bronchoscopic and surgical airway interventions for patients with progressive symptoms and threatened airways.
CONCLUSIONS: Surgical and bronchoscopic management of laryngotracheal stenosis presents a unique challenge during the COVID-19 pandemic, requiring careful consideration of patient triage and the development of protocols that minimize risk to patients and healthcare professionals. Close collaboration between thoracic surgeons and anesthesiology teams is essential to safely navigate and handle these threatened airways while mitigating the risk of viral aerosolization.

暂无摘要。

Adult and pediatric laryngotracheal stenoses (LTS) comprise a wide array of various conditions that require precise preoperative assessment and classification to improve comparison of different therapeutic modalities in a matched series of patients. This consensus paper of the European Laryngological Society proposes a five-step endoscopic airway assessment and a standardized reporting system to better differentiate fresh, incipient from mature, cicatricial LTSs, simple one-level from complex multilevel LTSs and finally \"healthy\" from \"severely morbid\" patients. The proposed scoring system, which integrates all of these parameters, may be used to help define different groups of LTS patients, choose the best treatment modality for each individual patient and assess distinct post-treatment outcomes accordingly.

Surgical reconstruction of paediatric laryngotracheal stenosis (LTS) has only been developed over the last 30 years, but during that period great advances have been made, and the operation is now very much tailored to the needs of the individual patient. Closed (endoscopic) techniques have a very limited place in the correction of LTS. Of the open surgical techniques, laryngotracheal reconstruction (LTR) with cartilage grafting can precisely correct grade II and mild grade III stenosis with minimal morbidity and high decannulation rates. Partial cricotracheal resection (PCTR) can deliver high success rates for more severe stenoses, but it is a more complex procedure. Because LTR is more straightforward, it tends to be preferred for grade II and mild grade III stenosis. For a suitably experienced surgeon, PCTR is the preferred option for grade IV and severe grade III stenosis, especially where there is a clear margin between the stenosis and the vocal cords. The best chance for the patient lies in the first operation: this means that the surgeon managing the problem must be fully trained in paediatric airway endoscopy and laryngotracheal surgery, since inappropriate initial management of LTS may lead to permanent intractable sequelae.