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

Background: The positioning of the stent at the flow-limiting segment is crucial for patients with extensive airway obstruction to relieve dyspnea. However, CT and flow-volume curves cannot detect the area of maximal obstruction. Objectives: The aim of this study is to physiologically evaluate extensive airway obstruction during interventional bronchoscopy. Methods: We prospectively measured point-by-point lateral airway pressure (P_lat) at multiple points from the lower lobe bronchus to the upper trachea using a double-lumen catheter in 5 patients. The site of maximal obstruction was evaluated continuously to measure point-by-point P_lat at multiple points when the airway catheter was withdrawn from the lower lobe bronchus to the upper trachea. Results: Remarkable pressure differences occurred at the site of maximal obstruction assessed by point-by-point P_lat measurements. After initial stenting in 1 case, migration of the maximal obstruction to a nonstented segment of the weakened airway was seen with extensive stenosis from the trachea to the bronchi. In the second case, in addition to radiological analysis, point-by-point P_lat measurements could identify the location of the maximal obstruction which contributed to dyspnea. Conclusions: Point-by-point P_lat measurement could be used to detect the site of maximal obstruction physiologically. Furthermore, P_lat measurement could assess the need for additional procedures in real time in patients with extensive airway obstruction.