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In vitro study of the safety limits of bronchoscopic argon plasma coagulation in the presence of airway stents
Author(s) -
COLT Henri G.,
CRAWFORD Stephen W.
Publication year - 2006
Publication title -
respirology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.857
H-Index - 85
eISSN - 1440-1843
pISSN - 1323-7799
DOI - 10.1111/j.1440-1843.2006.00890.x
Subject(s) - medicine , argon plasma coagulation , airway , silicone , stent , bronchoscopy , surgery , endoscopy , chemistry , organic chemistry
Objective and background: The purpose of this study was to identify the safety limits of bronchoscopic argon plasma coagulation (APC) around indwelling airway stents. Methodology: This is an experimental in vitro study simulating a patient‐care environment. Uncovered and covered Nitinol (Ultraflex), uncovered and covered Wallstent and studded silicone stents were deployed in the tracheobronchial tree of a ventilated and oxygenated heart–lung block from an expired pig. APC was performed at power settings of 40 and 80 W using F I O 2 of 0.21, 0.40 and 1.00 and an argon gas‐flow rate of 0.8 L/min through a flexible fiberoptic bronchoscope. The primary outcome was the time taken for the APC to cause stent damage. Stent damage was defined as discoloration, ignition or rupture. Results: Airway fires involving all five stents consistently occurred in the presence of 100% oxygen at powers of 40 W and 80 W. At lower F I O 2 (0.21 and 0.40) silicone stents were not damaged at 40 W and 80 W. Uncovered Ultraflex stents were undamaged using 40 W at either F I O 2 (0.21 and 0.40), but could be damaged using both F I O 2 levels when the power was increased to 80 W. Covered Ultraflex and both uncovered and covered Wallstents were damaged at both power settings (40 W and 80 W) and F I O 2 (0.21 and 0.40) levels, with a trend towards earlier damage using higher F I O 2 and power. Conclusion: Working within the parameters identified in this study (power 40 W, F I O 2 0.21, APC flow‐rate 0.8 L/min), APC is a safe method for tissue devitalization and destruction and avoids the risk of airway stent ignition, especially if short bursts of APC are employed. The safety limits identified using an F i O 2 of 0.4, however, are also important because some patients undergoing resection may require oxygen therapy.