中央气道阻塞（CAO）见于各种恶性和非恶性气道疾病，与不良预后相关。 CAO 的管理依赖于提供者培训和当地资源，这可能使临床方法和结果高度可变。我们回顾了当前的文献，并为 CAO 的管理提供了基于证据的建议。多学科专家小组使用 PICO（患者、干预、比较和结果）格式提出了关键问题，并使用 MEDLINE (PubMed) 和科克伦图书馆。该小组筛选了纳入的参考文献，并使用经过审查的评估工具来评估纳入研究的质量并提取数据，并对支持每项建议的证据水平进行了分级。使用改进的德尔菲技术就建议达成共识。总共审查了 9,688 篇摘要，评估了 150 篇全文文章，分析中纳入了 31 项研究。制定了一份良好实践声明和 10 项分级建议。证据的总体质量非常低。治疗性支气管镜检查可以改善恶性和非恶性 CAO 患者的症状、生活质量和生存率。适当时应采用多模式治疗方案，包括全身麻醉下的硬质支气管镜检查、肿瘤/组织清创、消融、扩张和支架置入。治疗选择和结果取决于 CAO 的潜在病因。强烈鼓励采用多学科方法并与患者共同决策。版权所有 © 2024 美国胸科医师学会。由爱思唯尔公司出版。保留所有权利。

Central airway obstruction (CAO), seen in a variety of malignant and non-malignant airway disorders, is associated with a poor prognosis. The management of CAO is dependent on provider training and local resources, which may make the clinical approach and outcomes highly variable. We reviewed the current literature and provided evidence-based recommendations for the management of CAO.A multidisciplinary expert panel developed key questions using the PICO (Patient, Intervention, Comparator, and Outcomes) format and conducted a systematic literature search using MEDLINE (PubMed) and the Cochrane Library. The panel screened references for inclusion and used vetted evaluation tools to assess the quality of included studies and extract data, and graded the level of evidence supporting each recommendation. A modified Delphi technique was used to reach consensus on recommendations.A total of 9,688 abstracts were reviewed, 150 full-text articles were assessed, and 31 studies were included in the analysis. One good practice statement and 10 graded recommendations were developed. The overall certainty of evidence was very low.Therapeutic bronchoscopy can improve the symptoms, quality of life, and survival of patients with malignant and non-malignant CAO. Multi-modality therapeutic options, including rigid bronchoscopy with general anesthesia, tumor/tissue debridement, ablation, dilation, and stent placement, should be utilized when appropriate. Therapeutic options and outcomes are dependent on the underlying etiology of CAO. A multidisciplinary approach and shared decision-making with the patient are strongly encouraged.Copyright © 2024 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.