Bethanechol in Tracheomalacia: Two Case Series and a Review of the Literature

Bass, Rosara; Santiago, Maria; Smith, Lee P.; Quinlan, Courtney M; Panitch, Howard B.; Giordano, Theresa; Piccione, Joseph

doi:10.1089/ped.2018.0880

Cited by 14 publications

(8 citation statements)

References 6 publications

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“…Stimulation of the muscarinic receptors in the airways should normally produce bronchospasm, but it seems to actually "open" an airway that is floppy due to malacia by increasing the trachealis muscle tone. There are no RCTs on its use but in a small series it appeared to be safe 144 .…”

Section: Recommendations On Therapeutic Interventions VII Management Of Tracheobronchomalaciamentioning

confidence: 96%

Care Recommendations for the Respiratory Complications of Esophageal Atresia-Tracheoesophageal Fistula: The International Network of Esophageal Atresia, Respiratory Complications Working Group

Koumbourlis

Belessis

Cataletto

et al. 2020

Preprint

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Tracheoesophageal fistula (TEF) with esophageal atresia (EA) is a common congenital anomaly that is associated with significant respiratory morbidity throughout life. The objective of this document is to provide a framework for the diagnosis and management of the respiratory complications that are associated with the condition. As there are no randomized controlled studies on the subject, a group of experts used a modification of the Rand Appropriateness Method to describe the various aspects of the condition in terms of their relative importance, and to rate the available diagnostic methods and therapeutic interventions on the basis of their appropriateness and necessity. Specific recommendations were formulated and reported as Level A, B, C based on whether they were based on "strong", "moderate" or "weak" agreement. The tracheomalacia that exists in the site of the fistula was considered the main abnormality that predisposes to all other respiratory complications due to airway collapse and impaired clearance of secretions. Aspiration due to impaired airway protection reflexes is the main underlying contributing mechanism. Flexible bronchoscopy is the main diagnostic modality, aided by imaging modalities, especially CT scans of the chest. Non-invasive positive airway pressure support, surgical techniques such as tracheopexy and rarely tracheostomy are required for the management of severe tracheomalacia. Regular long-term follow-up by a multidisciplinary team was considered imperative. Specific templates outlining the elements of the clinical respiratory evaluation according to the patients' age were also developed.

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Section: Recommendations On Therapeutic Interventions VII Management Of Tracheobronchomalaciamentioning

confidence: 96%

Care Recommendations for the Respiratory Complications of Esophageal Atresia-Tracheoesophageal Fistula: The International Network of Esophageal Atresia, Respiratory Complications Working Group

Koumbourlis

Belessis

Cataletto

et al. 2020

Preprint

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“…Although a similar approach can be provided with pressure‐targeted modes of ventilation, a volume‐targeted mode of synchronized ventilation facilitates continued delivery of the larger rated breaths even when airway resistance is altered by secretions or other changes in lung mechanics. Finally, in treating severe airways malacia, some centers have reported successful treatment using cholinergic stimulation with pharmacologic agents (such as enteral bethanechol) to increase airway smooth muscle tone and prevent collapse 31,32 …”

Section: Acute Versus Chronic Strategies For Ventilation In Sbpdmentioning

confidence: 99%

Chronic respiratory failure in bronchopulmonary dysplasia

Baker

2021

Pediatric Pulmonology

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Although survival has improved dramatically for extremely preterm infants, those with the most severe forms of bronchopulmonary dysplasia (BPD) fail to improve in the neonatal period and go on to develop chronic respiratory failure. When careful weaning of respiratory support is not tolerated, the difficult decision of whether or not to pursue chronic ventilation via tracheostomy must be made. This requires shared decision‐making with an interdisciplinary medical team and the child's family. Although they suffer from increased morbidity and mortality, the majority of these children will survive to tolerate ventilator liberation and tracheostomy decannulation. Care coordination for the technology‐dependent preterm infant is complex, but there is a growing consensus that chronic ventilation can best support neurodevelopmental progress and improve long‐term outcomes.

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“…En el contexto de episodios obstructivos bronquiales recidivantes (SBOR), que se imbrican con las TM, ya que comparten el mismo grupo etario de mayor prevalencia (menores de 3 años), se debe evitar los broncodilatadores β2 adrenérgicos, ya que pueden empeorar la obstrucción de la vía aérea al disminuir el tono de la musculatura lisa traqueobronquial (2), en cambio sí se ha documentado un efecto favorable del antimuscarínico bromuro de ipratropio (26), lo que puede deberse a su acción en las secreciones o en el tono de las vías aéreas. El uso de un agonista muscarínico inhalado (bethanechol) ha mostrado mejor calidad de vida en un par de series de pacientes (27) pero no se usa rutinariamente (3). También en el contexto de SBOR hay un excesivo uso de corticoides inhalados en TM-TBM y en la medida que se diagnostique precozmente la malacia de la vía aérea habrá un menor uso erróneo de TM= traqueomalacia, IRA = infección respiratoria aguda, PEP = presión positiva espiratoria, SBO = sindrome bronquial obstructivo, ERGE = enfermedad por reflujo gastroesofágico, CPAP = presión positiva contínua en vía aérea, BiPAP = presión positiva en vía aérea de dos niveles, CNAF = cánula nasal de alto flujo tratamientos antiasmáticos.…”

Section: Tratamientounclassified

Traqueomalacia, Diagnóstico Y Alternativas Terapéuticas

León¹

2021

Neumol Pediatr

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La traqueomalacia (TM) consiste en una excesiva colapsabilidad traqueal debida a una anomalía estructural del cartílago y/o de la pared membranosa posterior. Cuando se extiende a uno o ambos bronquios principales se denomina traqueobroncomalacia (TBM). Considerando diferentes clasificaciones, la mayoría de las TM son adquiridas, localizadas e intratorácicas. El diagnóstico clínico es difícil porque los síntomas son inespecíficos y se superponen con los de otras enfermedades respiratorias crónicas. Los síntomas más frecuentes incluyen estridor espiratorio, tos perruna e infecciones respiratorias recurrentes, en los casos más graves se presentan episodios de dificultad respiratoria severa, cianosis e incluso muerte súbita. La fibrobroncoscopía sigue siendo el método diagnóstico estándar de oro, complementándose con la tomografía computarizada que es esencial en la visualización de las estructuras adyacentes a la vía aérea. En los casos leves el tratamiento es conservador, considerando la resolución espontánea de la mayoría de los casos hacia los 2 años de edad. En los pacientes más sintomáticos la estrategia terapéutica se debe evaluar caso a caso, siendo la presión positiva contínua en vía aérea (no invasiva o invasiva por traqueostomía) el tratamiento más utilizado. En las TM-TBM más severas, entre posibles tratamientos que incluyen cirugía traqueal y prótesis en la vía aérea, lo más usado es aortoarteriopexia y traqueopexia, a la espera de resultados promisorios de mallas endoluminales biodegradables y prótesis reabsorbibles personalizadas impresas en 3D.

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Bethanechol in Tracheomalacia: Two Case Series and a Review of the Literature

Cited by 14 publications

References 6 publications

Care Recommendations for the Respiratory Complications of Esophageal Atresia-Tracheoesophageal Fistula: The International Network of Esophageal Atresia, Respiratory Complications Working Group

Care Recommendations for the Respiratory Complications of Esophageal Atresia-Tracheoesophageal Fistula: The International Network of Esophageal Atresia, Respiratory Complications Working Group

Chronic respiratory failure in bronchopulmonary dysplasia

Traqueomalacia, Diagnóstico Y Alternativas Terapéuticas

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