Safety and Clinical Utility of Flexible Bronchoscopic Cryoextraction in Patients With Non-neoplasm Tracheobronchial Obstruction: A Retrospective Chart Review

Background:Airway obstruction from blood clots, airway secretions, and foreign bodies is a potentially life-threatening condition. Optimal management of this problem, whether by rigid or flexible bronchoscopy, has not been well studied. We report our single-center experience on the safety and clinical utility of cryoprobe extraction for this indication. Methods:We performed a retrospective chart review from January 2006 to November 2014 of all subjects aged 18 and older who underwent flexible bronchoscopic cryoprobe extraction. Subjects with obstruction due to benign or malignant neoplasm or airway stenosis were excluded. Results:A total of 38 cryotherapy sessions performed on 30 subjects were identified for inclusion. Cryoprobe extraction was successful in reestablishing airway patency in 32/38 (84%) sessions overall and in 24/26 (92%) for blood clots, 4/6 (67%) for mucous plugging, 2/4 (50%) for foreign bodies, and 2/2 (100%) for plastic bronchitis. Twenty-one of 31 (68%) sessions resulted in improvement in oxygenation or ventilation. There was 1 complication related to sedation. Conclusions:We conclude that flexible bronchoscopic cryoprobe extraction of blood clots, mucous secretions, plastic bronchitis, and foreign bodies is a safe and effective option. It can be safely performed at the bedside and in many cases eliminates the need for rigid bronchoscopy.

[1]  D. B. Thomson.  Endobronchial streptokinase to dissolve a right mainstem clot. , 1986, Chest.

[2]  P. Mathur,et al.  Fiberoptic bronchoscopic cryotherapy in the management of tracheobronchial obstruction. , 1996, Chest.

[3]  S. Sahn,et al.  Airway obstruction arising from blood clot: three reports and a review of the literature. , 1999, Chest.

[4]  Hemorrhagic Tracheobronchial Obstruction , 2001 .

[5]  J. Vergnon,et al.  Cryotherapy to Extract Obstructing Blood Clots , 2002 .

[6]  M. Noppen,et al.  Successful Removal of a Massive Endobronchial Blood Clot by Means of Cryotherapy , 2005 .

[7]  T. Wibmer,et al.  Endobronchial tumor debulking with a flexible cryoprobe for immediate treatment of malignant stenosis. , 2010, The Journal of thoracic and cardiovascular surgery.

[8]  T. Wibmer,et al.  Removal of an aspirated foreign body with a flexible cryoprobe. , 2010, Respiratory care.

[9]  T. Beyer,et al.  Cryobiopsy increases the diagnostic yield of endobronchial biopsy: a multicentre trial , 2011, European Respiratory Journal.

[10]  M. Kramer,et al.  Transbronchial cryo‐biopsy in lung transplantation patients: First report , 2013, Respirology.

[11]  H. Youness,et al.  Bronchoscopic cryoextraction: a novel approach for the removal of massive endobronchial blood clots causing acute airway obstruction , 2013 .

[12]  T. Franquet,et al.  Diagnostic yield of transbronchial cryobiopsy in interstitial lung disease: A randomized trial , 2014, Respirology.

[13]  Jae Ho Lee,et al.  Successful Removal of Endobronchial Blood Clots Using Bronchoscopic Cryotherapy at Bedside in the Intensive Care Unit , 2014, Tuberculosis and respiratory diseases.

[14]  N. Sriratanaviriyakul,et al.  Safety and Clinical Utility of Flexible Bronchoscopic Cryoextraction in Patients With Non-neoplasm Tracheobronchial Obstruction: A Retrospective Chart Review , 2015, Journal of bronchology & interventional pulmonology.

[15]  M. Kramer,et al.  Retrieval of various aspirated foreign bodies by flexible cryoprobe: in vitro feasibility study , 2015, The clinical respiratory journal.