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Assessment of Extensive Airway Obstruction Using Point-by-Point Lateral Pressure Measurements during Bronchoscopy.

Hiroki Nishine1, Takehiko Hiramoto1, Hiroshi Handa1

  • 1Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan.

Respiration; International Review of Thoracic Diseases
|May 4, 2021
PubMed
Summary

Physiologically identifying the maximal airway obstruction is key for treating extensive airway obstruction. Point-by-point lateral airway pressure measurements can precisely locate this obstruction, guiding effective stenting and procedures.

Keywords:
Flow limitationMaximal obstructionMigrationPressure difference

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Area of Science:

  • Pulmonary Medicine
  • Interventional Pulmonology
  • Respiratory Physiology

Background:

  • Accurate stent placement in the flow-limiting segment is vital for managing extensive airway obstruction and relieving dyspnea.
  • Current imaging techniques like CT and flow-volume curves are insufficient for pinpointing the precise area of maximal obstruction.

Purpose of the Study:

  • To physiologically evaluate extensive airway obstruction during interventional bronchoscopy.
  • To determine the utility of point-by-point lateral airway pressure measurements in identifying the site of maximal airway obstruction.

Main Methods:

  • Prospective measurement of point-by-point lateral airway pressure (Plat) using a double-lumen catheter in 5 patients.
  • Measurements were taken at multiple points from the lower lobe bronchus to the upper trachea.
  • Continuous evaluation of the maximal obstruction site during catheter withdrawal.

Main Results:

  • Significant pressure differences were observed at the maximal obstruction site using point-by-point Plat measurements.
  • In one case, maximal obstruction migrated to a nonstented segment after initial stenting.
  • Point-by-point Plat measurements, alongside radiological analysis, identified the maximal obstruction site contributing to dyspnea in another case.

Conclusions:

  • Point-by-point Plat measurement is a viable method for physiologically detecting the site of maximal airway obstruction.
  • Plat measurements can provide real-time assessment for the need for additional procedures in patients with extensive airway obstruction.