Differences in Flexible and Rigid Bronchoscopy for Assessment of Tracheomalacia

Abstract

Objectives/Hypothesis Both flexible and rigid bronchoscopy can be used to assess tracheomalacia; however, there is limited evidence comparing the two techniques. The objective of this study was to compare flexible and rigid bronchoscopy for evaluating the location and severity of tracheomalacia in children. Study Design Retrospective case series. Methods This was a retrospective study of children with both flexible and rigid bronchoscopy under the same sedation. All bronchoscopies were reviewed by three bronchoscopists for the location and severity of tracheomalacia. The location of collapse was defined as upper, middle, or lower trachea, and the severity of collapse was defined as none (0%–25% collapse), mild/moderate (26%–75% collapse), and severe (>75% collapse). Results Twenty‐one patients were recruited for this study with a variety of neonatal respiratory diseases. There was 94% agreement (κ = 0.64) for assessment of tracheomalacia in the upper trachea. However, agreement was only 75% (κ = 0.50) in the middle trachea and 76% (κ = 0.52) in the lower trachea. In the subset of patients without tracheostomy, agreement improved to 100%, 88%, and 82% for the upper, middle, and lower trachea, respectively. There was poor correlation for tracheomalacia severity in the middle trachea (ρ = 0.30, P = .2) and moderate in the lower trachea (ρ = 0.63, P = .002). Conclusions Although there is moderate agreement between flexible and rigid bronchoscopy for evaluating the presence of tracheomalacia, there can be differences in the two techniques, particularly when assessing severity of airway collapse. Future studies will be needed to understand factors that result in the discordance of flexible and rigid bronchoscopy for assessing airway dynamics. Level of Evidence 4 Laryngoscope, 131:201–204, 2021

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

“…Level A Recommendations Recommendation 1: Flexible bronchoscopy is the gold standard for the evaluation of TBM Level B Recommendations Recommendation 5: Multi-detector CT scan is an accurate method of assessing TBM Re Level C Recommendations Recommendation 7: Tidal flow-volume loops are a reliable way of assessing the severity o Flexible bronchoscopy is considered the gold standard for the evaluation of the presence and severity of TBM. Rigid bronchoscopy tends to underestimate the degree of the tracheal collapse because it "stents" the airway 51,[86][87][88] .…”

Care recommendations for the respiratory complications of esophageal atresia‐tracheoesophageal fistula

“…Rigid bronchoscopy tends to underestimate the degree of the tracheal collapse because it "stents" the airway. 50,[85][86][87] There was moderate agreement regarding the use of standard chest CT because it may not capture the dynamic changes of the tracheobronchial lumen that occur during the respiratory cycle (especially with cough). Inspiratory and expiratory dynamic multidetector chest CT scans were considered superior because they are fast, relatively inexpensive, and provide additional and detailed information about the airways, the lung parenchyma, and the thoracic vasculature.…”

Safety application of muscle relaxants and the traditional low-frequency ventilation during the flexible or rigid bronchoscopy in patients with central airway obstruction: a retrospective observational study

“…Flexible bronchoscopy was performed through a laryngeal mask airway or endotracheal tube, which can create auto positive end expiratory pressure and alter airway mechanics with a minimum of sedation. Rigid bronchoscopy relies on the use of a laryngoscope and either a rigid ventilating bronchoscope or Hopkins rod telescope, which can alter the airway by stenting the airway open, and often requires a deeper level of sedation [14]. There are some debates as which one is better than the other, and whether the use of muscle relaxants is safe and indispensable in this procedure [15][16][17][18][19][20].…”