30th December 2024

Management of SVCO

In most cases of SVCO there is time to organise a tissue biopsy prior to definitive treatment, however if there is evidence of respiratory compromise or raised intracranial pressure, definitive treatment must not be delayed.

Emergency management of SVCO

If there are features of respiratory compromise (stridor, desaturation or dyspnoea), then initially:

1. Sit patient upright or elevate head and neck; deliver 100% FiO2 (fraction of inspired oxygen); establish IV access
2. Start high-dose corticosteroids to reduce perilesional oedema (16 mg dexamethasone stat then continue OD). There is little evidence that steroids are beneficial in most non-haematological causes of SVCO, however they continue to be prescribed due to relatively low side effect profile in short duration
3. Check arterial blood gas and monitor saturations; if in respiratory failure, involve ITU and ENT
4. An emergency tracheostomy may be required if severe airway compromise

Ongoing and definitive management of SVCO

Ongoing management requires full investigation as discussed above, followed by treatment to relieve the obstruction (Table 13). Generally, stenting is preferred as it relieves symptoms quickly, is very successful and can be re-attempted if symptoms recur.