Current management and outcome of tracheobronchial malacia and stenosis presenting to the paediatric intensive care unit

Inwald, David; Roebuck, Derek J.; Elliott, Martin J.; Mok, Quen

doi:10.1007/s001340000822

Cited by 21 publications

(11 citation statements)

References 22 publications

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“…Its management can be very challenging. Three strategies can be employed, as we have described elsewhere [38] in the management of conventional tracheo-bronchomalacia. Prolonged ventilatory support with CPAP may work, but a few patients have required tracheostomy and 'home' BIPAP support for up to 2 years.…”

Section: Those Related To Repair Of Associated Lesions Andmentioning

confidence: 99%

The management of congenital tracheal stenosis

Elliott

Roebuck

Noctor

et al. 2003

International Journal of Pediatric Otorhinolaryngology

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105

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Section: Those Related To Repair Of Associated Lesions Andmentioning

confidence: 99%

The management of congenital tracheal stenosis

Elliott

Roebuck

Noctor

et al. 2003

International Journal of Pediatric Otorhinolaryngology

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105

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“…The mechanisms include anomalous relationships between the tracheobronchial tree and vascular structures (complete or partial vascular rings) or result from extrinsic compression caused by dilated great vessels, left atrial enlargement, massive cardiomegaly, or postoperative reconstructed aortic arches [7]. Survival outcome analysis among patients showed that patients with cardiac/syndromic anomalies had inferior survival compared to patients with primary airway stenosis [6]. In this situation, flexible bronchoscopy is necessary to identify complete tracheal rings, the severity of stenosis, and any dynamic collapse of the airway [2].…”

Section: Discussionmentioning

confidence: 98%

Anomalous ascending aorta causing severe compression of the left bronchus in an infant with ventricular septal defect and pulmonary atresia

Chen

Chiu

et al. 2008

Eur J Pediatr

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Tracheobronchial compression by cardiovascular structures complicates the course after surgery of congenital heart disease. A 2-month-old boy with ventricular septal defect, pulmonary atresia, and velocardiofacial syndrome had severe left main bronchus obstruction due to external compression by an anomalously oriented ascending aorta. The patient's hypoxemic episodes necessitated extracorporeal membrane oxygenation. We inserted a stent in the left bronchus to open the airway, but the stent was crushed by the anomalous aorta. We later surgically rerouted the aorta and finally restored the patency of the left main bronchus. However, the patient died of fungemia, without being weaned from extracorporeal membrane oxygenation. We conclude that surgery is necessary instead of stent implantation to relieve the external compression of the left bronchus from a vessel with systemic arterial pressure.

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“…Figure 9 shows the Kaplan–Meier curve of survival in different diagnostic groups. We found that associated comorbidity was more predictive of mortality, and patients with cardiac problems or who were syndromic had a much poorer outcome than patients who had tracheomalacia associated with trachea-esophageal fistula, as an isolated primary airway problem or from prematurity (44). …”

Section: Prognosismentioning

confidence: 90%

Airway Problems in Neonates—A Review of the Current Investigation and Management Strategies

Mok

2017

Front. Pediatr.

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Airway problems in the neonatal population are often life threatening and raise challenging issues in diagnosis and management. The airway problems can result from congenital or acquired lesions and can be broadly classified into those causing obstruction or those due to an abnormal “communication” in the airway. Many different investigations are now available to identify the diagnosis and quantify the severity of the problem, and these tests can be simple or invasive. Bronchography and bronchoscopy are essential to determine the extent and severity of the airway problem and to plan treatment strategy. Further imaging techniques help to delineate other commonly associated abnormalities. Echocardiography is also important to confirm any associated cardiac abnormality. In this review, the merits and disadvantages of the various investigations now available to the clinician will be discussed. The current therapeutic strategies are discussed, and the review will focus on the most challenging conditions that cause the biggest management conundrums, specifically laryngotracheal cleft, congenital tracheal stenosis, and tracheobronchomalacia. Management of acquired stenosis secondary to airway injury from endotracheal intubation will also be discussed as this is a common problem. Slide tracheoplasty is the preferred surgical option for long-segment tracheal stenosis, and results have improved significantly. Stents are occasionally required for residual or recurrent stenosis following surgical repair. There is sufficient evidence that a multidisciplinary team approach for managing complex airway issues provides the best results for the patient. There is ongoing progress in the field with newer diagnostic tools as well as development of innovative management techniques, such as biodegradable stents and stem cell-based tracheal transplants, leading to a much better prognosis for these children in the future.

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Current management and outcome of tracheobronchial malacia and stenosis presenting to the paediatric intensive care unit

Cited by 21 publications

References 22 publications

The management of congenital tracheal stenosis

The management of congenital tracheal stenosis

Anomalous ascending aorta causing severe compression of the left bronchus in an infant with ventricular septal defect and pulmonary atresia

Airway Problems in Neonates—A Review of the Current Investigation and Management Strategies

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