Clinical outcomes of rigid bronchoscopic airway interventions: insights from an Indian tertiary care center

Rigid bronchoscopy (RB) forms an indispensable part of the interventional bronchoscopist's skills, allowing the performance of complex airway interventions for a variety of benign and malignant airway disorders. Experiential data on the procedure is limited, particularly in adults. We conducted a retrospective analysis of medical records from 82 adult patients who underwent RB at our center. The primary objective was to evaluate the clinical indications, procedural outcomes, complication rates, and overall efficacy of RB in this cohort. Collected data included patient demographics, presenting symptoms, etiological diagnoses, and anesthesia-related parameters such as induction agents, maintenance protocols, sedation strategies, and the use of neuromuscular blockade. Post-procedural outcomes and follow-up mortality were also assessed. The mean patient age was 56.2±12.6 years, with 71.9% males. Common symptoms were cough (90.2%) and dyspnea (82.9%). Malignancies accounted for 90.2% of cases, with lung cancer being the most prevalent (68.2%). RB was primarily performed for stenting (63.4%) and tumor debulking (29.2%). Total intravenous anesthesia was used in 92.6%, with mean induction and reversal times of 75.3±4.3 seconds and 10.69±2.4 minutes, respectively. Minor complications occurred in 29.3% (bleeding 29.3%, bronchospasm 17.1%, and hypoxia 13.4%) and major complications in 2.4%. After the procedure, immediate extubation was achieved in 49 patients (59.8%), while 24 (29.3%) required short-term ventilator support (<24 h) and 9 (11.0%) required prolonged support (>24 h). The median hospital stay was 7 days (interquartile range 5-11). Symptomatic improvement at discharge was observed in 72/82 patients (87.8%). In-hospital mortality was 6.1% (5/82), mainly due to severe infections (hospital-acquired or ventilator-associated pneumonia) or massive endobronchial bleeding. Among patients with available follow-up (n=52), 3-month mortality was 11.5% (n=6). In this real-world cohort, RB demonstrated a high success rate with minimal complications, reinforcing its role as a critical tool in managing complex airway conditions. The procedure demonstrated high efficacy, particularly in malignant cases, with acceptable complication rates. Dedicated training is essential to enhance experience, gain expertise, and ensure optimal outcomes while minimizing procedural risks.