Cryotherapy in the paediatric airway: Indications, success and safety

Fecha de publicación: 01/08/2022 Fecha Ahead of Print: 01/08/2022

Autores de IIS La Fe

• Santiago Pérez Tarazona

  Autor

• Enrique Cases Viedma

  Autor

Participantes ajenos a IIS La Fe

• Schramm D
• Freitag N
• Kotz, Karsten
• Iglesias-Serrano I
• Culebras-Amigo M
• Koblizek V
• Srikanta JT
• Durdik P
• Darwiche K
• Rubak S
• Stafler P

Grupos

• Infecciones Respiratorias

  Investigador Principal

  Raúl Méndez Ocaña

• Neumología

  

  Leader

  Miguel Ángel Martínez García

• Perinatología

  

  Leader

  Máximo Vento Torres

Abstract

Background and objective Cryotherapy in interventional bronchoscopy is a new treatment modality, which has recently been made available for the paediatric airway. Lack of experience and safety concerns have led to hesitant adaptation. The aim of this study was to assess indications, success rates and complications of airway cryotherapy in children. Methods Bronchoscopists from medical centre performing cryotherapy in patients between 0 and 18 years were invited to participate in a prospective study based on an online questionnaire. Patient and participant data were collected between June 2020 and June 2021. Results A total of 69 cryotherapy procedures were performed in 57 patients a for three main indications: Biopsy (30), restoration of airway patency (23) and foreign body aspiration (16). The overall success rate was 93%, the remaining 7% were performed for foreign body removal and required a switch of technique. Restoration of airway patency was successfully applied in various pathologies, including mucus plugs, bronchial casts and post traumatic stenosis. The diagnostic yield of transbronchial biopsies was 96%. No severe complications were encountered; one pneumothorax following a cryobiopsy required a chest drain for 48 h. No child was admitted to intensive care or died from a procedural complication. Conclusion In this largest paediatric case collection to date, cryotherapy was safe and carried a high success rate. Cryobiopsy compares favourably to the widely used forceps biopsy and could replace it in the future. Paediatric bronchoscopists are encouraged to add cryotherapy to their armamentarium of airway interventions.

© 2022 The Authors. Respirology published by John Wiley & Sons Australia, Ltd on behalf of Asian Pacific Society of Respirology.

Keywords

• airway obstruction; cryotherapy; cryobiopsy; foreign body removal; interventional bronchoscopy; paediatric bronchoscopy