Expiratory Central Airway Collapse and Pneumatic Stenting With Continuous Positive Pressure Titration: A Technique Description

To provide a standardized step-by-step guide for continuous positive airway pressure (CPAP) titration during dynamic flexible bronchoscopy (DB). This descriptive study included patients referred to Mayo Clinic for concern regarding expiratory central airway collapse (ECAC) who underwent DB with CPAP titration from April 5, 2023, to February 9, 2024. Demographic characteristics, comorbidities, pulmonary function test results, and procedural details such as anesthesia protocols, CPAP settings, outcomes of pneumatic stenting, complications, and severity of ECAC were recorded. The procedure is performed with the patient under light sedation. After assessing dynamic breathing maneuvers for airway collapsibility, a CPAP mask is attached with initial pressure set at 6 cm H2O and titrated in increments of 2 cm H2O until successful pneumatic stenting of the airway. The study group included 33 patients. The mean ± SD age was 67.45±8.73 years, 21 (63.6%) were female, and 26 (78.8%) presented with shortness of breath. The median ECAC severity score was 11 (IQR, 7 to 13). Of the 32 patients who underwent pulmonary function tests, 20 (62.5%) had normal results and 12 (37.5%) had a serrated flow-volume loop. The median CPAP setting to maintain airway patency was 12 cm H2O (IQR,10 to 14 cm H2O). We reported no intraprocedural or postprocedural complications. This study provides a detailed guide to performing CPAP titration during DB. We believe that this description of technique will support a systematic approach for further research to assess the impact of pneumatic stenting in ECAC.