THE USE OF EXPANDABLE METAL STENTS TO FACILITATE EXTUBATION IN PATIENTS WITH LARGE AIRWAY-OBSTRUCTION

Objective: To determine the clinical utility of placing airway stents to facilitate weaning in ventilator-dependent patients with large airw ay obstruction. Methods: A chart review of mechanically ventilated pat ients who received expandable metal airway stents to attempt a facilit ation of weaning. Results: Eight patients, 3 women and 5 men, ranging in age from 37 to 82 years, had respiratory failure associated with la rge airway obstruction and underwent flexible bronchofluoroscopic plac ement of 12 expandable metal stents (7 Wallstents [Schneider; Minneapo lis, MN], 2 Palmaz [Johnson & Johnson; Warren, NJ], and 3 Ultraflex [M icroinvasive; Natick MA]), Six had respiratory failure that was second ary to malignant airway disease, and two had benign airway disease. Se ven patients with tracheal or mainstem bronchial obstruction were wean ed from the ventilator within 0 to 11 days of stent placement after ha ving previously required mechanical ventilation from 2 to 52 days. The re were no associated complications, Following prolonged attempts at w eaning, one patient with lobar bronchus obstruction died after mechani cal ventilation was withdrawn. Conclusions: Expandable metal airway st ents may be safely deployed in mechanically ventilated patients and ca n facilitate weaning from the mechanical ventilator, Mechanically vent ilated patients with tracheal and mainstem bronchus obstruction are th e best candidates for deployment of expandable airway stents to facili tate weaning.