Emergency management for congenital tracheal stenosis with endoluminal stenting in pediatric intensive care units

Xing, Xuan; Ding, Hui; Liu, Xicheng; Zhu, Bin; Feng, Zhichun

doi:10.1177/1753465816645478

Cited by 9 publications

(5 citation statements)

References 17 publications

(21 reference statements)

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“…Two series with five patients each reported the long-term outcome of stents used in tracheal stenosis after endoscopic dilation, with good functional outcomes, but a high complication rate [103,134]. Another case series reported on rapamycin-eluting stents after balloon dilation of congenital tracheal stenosis in eight infants, but with only a short follow-up [135]. A retrospective study of 21 severely sick patients in whom stenting was used as the last resort reported clinical improvement in 18 (85%) patients with complications requiring endoscopic treatment or removal of the stent in five (27%) of them; stent related mortality was 4% [136].…”

Section: Airway Stentsmentioning

confidence: 99%

ERS statement: interventional bronchoscopy in children

et al. 2017

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Paediatric airway endoscopy is accepted as a diagnostic and therapeutic procedure, with an expanding number of indications and applications in children. The aim of this European Respiratory Society task force was to produce a statement on interventional bronchoscopy in children, describing the evidence available at present and current clinical practice, and identifying areas deserving further investigation. The multidisciplinary task force panel performed a systematic review of the literature, focusing on whole lung lavage, transbronchial and endobronchial biopsy, transbronchial needle aspiration with endobronchial ultrasound, foreign body extraction, balloon dilation and occlusion, laser-assisted procedures, usage of airway stents, microdebriders, cryotherapy, endoscopic intubation, application of drugs and other liquids, and caregiver perspectives. There is a scarcity of published evidence in this field, and in many cases the task force had to resort to the collective clinical experience of the committee to develop this statement. The highlighted gaps in knowledge underline the need for further research and serve as a call to paediatric bronchoscopists to work together in multicentre collaborations, for the benefit of children with airway disorders.

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Section: Airway Stentsmentioning

confidence: 99%

ERS statement: interventional bronchoscopy in children

et al. 2017

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“…Cryotherapy has been used for restoration of airway patency in different conditions including traumatic tracheal stenosis [12], endobronchial casts or mucus plugs [13], removal of foreign bodies [7] and the recanalization of obstructed bronchial stents [14].…”

Section: Discussionmentioning

confidence: 99%

Cryoprobe for Endoscopic Enucleation in Children with Pulmonary Tuberculosis: Effective but Not Without Danger – Case Report and Review of Literature

Goussard,

Eber,

Venkatakrishna

et al. 2024

Respiration

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Introduction: Tuberculosis (TB) in children under 15 years often results in airway compression, with bronchus intermedius (BI) being the most common site. Endoscopic enucleations can be used to remove lymph nodes and establish an airway in severe cases. Both rigid and flexible bronchoscopy are suitable, with alligator forceps being preferred for its ability to extract tissue. Recent studies have also explored cryoprobe enucleation. Case Presentation: An HIV-positive boy with persistent symptoms after 9 months of TB treatment was diagnosed based on his mother’s and sister's Xpert MTB/RIF positive status. He was started on 4-drug TB treatment, but the child remained clinically symptomatic with abnormal chest X-ray and unconfirmed TB. Bronchoscopy was performed, revealing complete obstruction of BI due to caseating granulomas causing collapse of the right middle and lower lobes. Cryotherapy was used to recanalise the airway, and follow-up bronchoscopy confirmed patent BI. Conclusion: While cryotherapy was effective in the restoration of airway patency in this case, there is a lack of knowledge about its use in children.

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“…Multiple stents can be removed in batches so as to avoid excessive damage to the airway that may occur when multiple stents are removed all at once. After the stent is removed, the wound can be treated with CO 2 cryotherapy to reduce the rate of granulation tissue hyperplasia (12).…”

Section: Discussionmentioning

confidence: 99%

Follow-Up Investigation of 41 Children After Metallic Airway Stent Implantation: An 8-Year Experience

Wang

Zhu

2020

Front. Pediatr.

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Objective: To present 8-year follow-up outcomes, treatment of complications, and prognosis in children with congenital tracheal stenosis after metallic airway stent implantation. Methods: Retrospective analysis was performed on the clinical records of children who had airway stents placed between May 20, 2011 and May 31, 2016, and on their follow-up records collected on November 31, 2019. Results: During the 8 years follow-up, 41 children underwent airway stenting under flexible bronchoscopy and participated in the follow-up investigation. There were 26 cases with left main bronchus (LMB) stenosis (63.4%), 16 cases with congenital tracheal stenosis (CTS, 39.0%), 12 cases with right main bronchus (RMB) stenosis (29.3%), and 1 case of subglottic stenosis (2.4%). A total of 76 stents were implanted, and 21 patients died after implantation. There were 34 children (82.9%) with congenital heart disease (CHD), while other diseases accounted for <5%. Among children with CHD and those with other conditions, the number of death cases was 19 and 2, respectively; no significant differences were observed between the two groups (P>0.05). The most frequent complications were increased airway secretion (75.8%), stent deformation (66.7%), and granulation tissue hyperplasia (60.6%). The airway stenosis (45.5%) and stent migration (12.1%) occurred at a moderate rate. The less common complications were airway softening (6.1%), and stent breakage (6.1%). Conclusions: The placement and removal of the metallic stent are convenient and quick procedures that can relieve the symptoms of dyspnea caused by airway stenosis in the case of an emergency. After stent implantation, the primary disease should be actively treated, and the stent should be removed as soon as possible after the cause of airway stenosis is successfully removed. Larger stents are more likely to cause complications; thus, a good follow-up system should be established to timely address all the complications.

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Emergency management for congenital tracheal stenosis with endoluminal stenting in pediatric intensive care units

Cited by 9 publications

References 17 publications

ERS statement: interventional bronchoscopy in children

ERS statement: interventional bronchoscopy in children

Cryoprobe for Endoscopic Enucleation in Children with Pulmonary Tuberculosis: Effective but Not Without Danger – Case Report and Review of Literature

Follow-Up Investigation of 41 Children After Metallic Airway Stent Implantation: An 8-Year Experience

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