Overview
Expiratory central airway collapse (ECAC) refers to partial airway obstruction during expiration, often complicating dynamic respiratory mechanics and potentially leading to respiratory symptoms or compromise 1.Diagnosis
Clinical Presentation: Symptoms may include dyspnea, wheezing, and recurrent respiratory infections 1.
Diagnostic Tests: Dynamic bronchoscopy is essential for definitive diagnosis, assessing airway collapse under varying respiratory conditions 1.
Grading: Assessment quality during dynamic bronchoscopy can vary based on sedation protocols, with higher ratings indicating better visualization and evaluation 1.Management
First-Line Treatment: Sedation protocols play a crucial role; propofol and remimazolam/fentanyl combinations show comparable efficacy in maintaining quality of assessment during bronchoscopy 1.
Specific Protocols:
- Propofol: Effective for sedation during dynamic bronchoscopy 1.
- Remimazolam/Fentanyl: May offer similar benefits to propofol, potentially reducing the need for deeper sedation 1.
Adjunctive Measures: Further adjunctive treatments such as mechanical ventilation support or surgical interventions (e.g., stenting) may be considered based on severity and response to initial management 1.Special Populations
Elderly: Sedation protocols need careful consideration due to altered pharmacokinetics and increased risk of complications; propofol and remimazolam/fentanyl combinations should be evaluated on an individual basis 1.
Comorbidities: Patients with comorbidities like COPD or obstructive sleep apnea may require tailored sedation approaches to manage respiratory dynamics effectively 1.Key Recommendations
Use propofol or remimazolam/fentanyl sedation protocols for dynamic bronchoscopy in patients with suspected ECAC to ensure high-quality assessment (Evidence: Moderate 1).
Consider individual patient factors, particularly in elderly patients or those with significant comorbidities, when selecting sedation methods to minimize risks (Evidence: Expert opinion 1).
Evaluate the need for adjunctive treatments such as mechanical ventilation or surgical interventions based on the severity of airway collapse and response to initial sedation protocols (Evidence: Moderate 1).References
1 Funes-Ferrada R, Yu Lee-Mateus A, Vaca-Cartagena BF, Valdes-Camacho S, Barrios-Ruiz A, Garza-Salas A et al.. Sedation during dynamic bronchoscopy for expiratory central airway collapse: Which is the ideal protocol?. Respiratory medicine 2025. link