Pediatric Tracheobronchomalacia and Major Airway Collapse

Abstract

Based on histopathologic, endoscopic, and clinical findings of the flaccid airway, new descriptive terms--major airway collapse types 1 through 3--are proposed to better define tracheobronchomalacia. A typing and grading system is offered to objectively analyze and compare clinical cases. Endoscopic and anesthetic techniques are presented for use in children with respiratory distress suggestive of tracheobronchomalacia. Spontaneous ventilation with laryngoscopic insufflation of anesthetic gases and the use of small-diameter telescopes without bronchoscopes are key elements for the examination of the dynamic pediatric airway. Pitfalls of classic bronchoscopy techniques are described that can lead to a missed diagnosis. Between 1987 and 1990, over 200 telescopic bronchoscopies were performed at Wilford Hall US Air Force Medical Center on 129 children 3 years old and younger with respiratory distress. By means of the described techniques, 38 children (30%) with major airway collapse were identified. Major airway collapse was associated with a variety of endoscopic and cardiac abnormalities. With the emergence of sophisticated neonatal pediatric respiratory care, a growing number of premature infants with major airway collapse are surviving. Early, precise endoscopic diagnosis allows optimal management.

Effect of Prenatal versus Postnatal Vitamin D Deficiency on Pulmonary Structure and Function in Mice

“…Tracheomalacia and bronchomalacia are common diseases of infancy, due to defective airway cartilage. In children undergoing bronchoscopy for respiratory distress or chronic wet cough, lower airway malacia is present in approximately 30% of patients (10). This increases to approximately 50% in premature infants (11), and in almost all infants who require chronic mechanical ventilation (12).…”

Adjusting the endotracheal tube tip in management of tracheomalacia in an infant

“…With FB, patient can breathing spontaneously under conscious sedation. This allows for more well-preserved airway dynamics than with rigid bronchoscopy during respiratory cycles and physical activity [15,16]. In unstable or intubated patients, the FB is usually through the ETT with or without ventilation support.…”

Bronchodilator responsiveness in a ventilator-dependent infant with severe tracheobronchomalacia

“…from secondary forms (external compression of the airways, etc.) of TBM [3], or to adequately measure the cartilage to posterior membrane ratio [9], nor is it crucial for determining the best treatment modality. The reason for a thorough examination is to try to avoid long-term MV and tracheostomy by alternative treatment modalities.…”