Implantation of metallic stent under direct visualization of flexible bronchoscope without fluoroscopic guidance on orotracheal intubated patients

Abstract

Background: Stent implantation has been used to liberate patients with severe airway stenosis and respiratory failure from mechanical ventilation; however, a rare clinical study is reported about metallic stent implantation via a flexible bronchoscope without using fluoroscopic guidance in ventilated patients.

Objectives: The present retrospective study aims to evaluate the feasibility, safety, efficacy, and complications of using a flexible bronchoscope without fluoroscopy to implant metallic stent in mechanically ventilated patients.

Methods: From April 2015 to April 2016, eight tracheobronchial metallic stents were implanted in six respiratory failure patients associated with central airway stenosis or fistula. First, a bronchoscope was inserted through an endotracheal tube into the trachea or bronchus, and a guide wire was placed into the stenosis site. The bronchoscope was reintroduced into the airway outside the endotracheal tube. Under bronchoscopic visualization, the delivery catheter was advanced over the guide wire to deploy the stent.

Results: These procedures were successfully performed in all patients, with three stents placed in the trachea and five stents in the main bronchus. The patients were all successfully liberated from mechanical ventilation. Five patients suffered from cough after the procedure. One patient, who received a covered metallic stent implantation in the left main bronchus, experienced increased mucus production. Granulation tissue formation was found in one patient. No patient presented with any stent migration or pneumothorax.

Conclusions: It is concluded that metallic stents can be safely implanted under the direct visualization of a bronchoscope without using fluoroscopic guidance in patients with respiratory failure to wean the patients from mechanical ventilation.