Chest
Volume 135, Issue 5, May 2009, Pages 1403-1404
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Tracheobronchoplasty for Severe Tracheobronchomalacia

https://doi.org/10.1378/chest.08-2660Get rights and content

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    Patients who are not suitable surgical candidates may be offered palliation of symptoms with long-term stent placement. Poor surgical candidates are those with such severe lung disease that they are not deemed fit to tolerate single-lung ventilation during TBP.14 The most important predictor of hypoxemia during one-lung ventilation is a low preoperative partial pressure of oxygen during spontaneous ventilation.15

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    Despite these concerns, we feel that the demonstrable improvement in anatomy contributes to the subjective improvement in dyspnea. Minimal increases in airflow may result in marked improvement in hyperinflation, dyspnea, and vital capacity, and it has been suggested that stabilization of the central airways might lead to more laminar flow accounting for this finding [18, 22]. This clearly deserves more extensive investigation going forward.

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    Although 7 classification systems have been proposed for patients with ECAC over the last 45 years,31 only recently has functional status been included as a separate independent criterion.5 Because the improvements in functional status seen in several studies were not associated with improvements in pulmonary function as measured by FEV1,34,35 other physiologic parameters, such as markers of hyperinflation, should perhaps also be included in a multidimensional classification system.38 The quantification of the severity of airway collapse remains empirical,31 and a correlation between the degrees of severity, functional status, and pulmonary physiology remains to be determined.

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