What is the key question?

• Cryotherapy is a reasonable modality to consider in the management of obstructive central airway lesions. However uncertainty exists as to the risk of complications, particularly bleeding. The authors retrospectively reviewed 262 cases of bronchial cryotherapy (BC) for central airway obstruction (CAO) to analyse the factors influencing adverse outcomes.

What is the bottom line?

• Logistic regression was used to identify factors associated with both success and complications. Most cases of BC were in patients with tumour related CAO (232/ 88.9%). 78 cases were associated with bleeding (33.5%). One case of severe bleeding occurred in the series (bleeding requiring transfusion, fresh frozen plasma, bronchial artery embolization, vasopressors or mechanical ventilation).
• Risk factors for bleeding in multivariate LR analysis were diabetes mellitus, respiratory failure before cryotherapy and distal airway atelectasis. Further risk factors in univariate analysis included age > 75 years, hypertension, upper lobe location of tumour and stent placement.

Why read on?

• This study suggests good results for CAO with BC. The study identifies several factors associated with higher risk for bleeding, which is a constant concern in these cases. In this retrospective group these factors suggest the need for further studies in this group using larger numbers and in more centres to control for patient and practitioner variables.