Tracheobronchomalacia diagnosed by tracheobronchography in ventilator-dependent infants

Manimtim, Winston M; Rivard, Douglas C.; Sherman, Ashley; Cully, B.; Reading, B.; Lachica, Charisse; Gratny, Linda L.

doi:10.1007/s00247-016-3685-9

Cited by 10 publications

(6 citation statements)

References 22 publications

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“…Tracheobronchography performed with low volumes of nonionic water-soluble contrast is safe [67], and useful in the evaluation of TBM because of its high spatial and temporal resolution (figure 2) [68]. Many centres continue to use tracheobronchography [12,67,[69][70][71], often in combination with flexible bronchoscopy [68]. Free breathing, as with many of the imaging techniques, is required for diagnostic accuracy [72].…”

Section: Tracheobronchographymentioning

confidence: 99%

ERS statement on tracheomalacia and bronchomalacia in children

et al. 2019

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Tracheomalacia and tracheobronchomalacia may be primary abnormalities of the large airways or associated with a wide variety of congenital and acquired conditions. The evidence on diagnosis, classification and management is scant. There is no universally accepted classification of severity. Clinical presentation includes early-onset stridor or fixed wheeze, recurrent infections, brassy cough and even near-death attacks, depending on the site and severity of the lesion. Diagnosis is usually made by flexible bronchoscopy in a free-breathing child but may also be shown by other dynamic imaging techniques such as low-contrast volume bronchography, computed tomography or magnetic resonance imaging. Lung function testing can provide supportive evidence but is not diagnostic. Management may be medical or surgical, depending on the nature and severity of the lesions, but the evidence base for any therapy is limited. While medical options that include bronchodilators, anti-muscarinic agents, mucolytics and antibiotics (as well as treatment of comorbidities and associated conditions) are used, there is currently little evidence for benefit. Chest physiotherapy is commonly prescribed, but the evidence base is poor. When symptoms are severe, surgical options include aortopexy or posterior tracheopexy, tracheal resection of short affected segments, internal stents and external airway splinting. If respiratory support is needed, continuous positive airway pressure is the most commonly used modality either via a face mask or tracheostomy. Parents of children with tracheobronchomalacia report diagnostic delays and anxieties about how to manage their child's condition, and want more information. There is a need for more research to establish an evidence base for malacia. This European Respiratory Society statement provides a review of the current literature to inform future study.

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Section: Tracheobronchographymentioning

confidence: 99%

ERS statement on tracheomalacia and bronchomalacia in children

et al. 2019

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“…TBM in children is defined as weakening of the airway wall due to softening of the cartilaginous rings, decreased tone of the airway smooth muscle and collapse. This results in increased airway compliance and reduction of the size of the airway lumen during expiration [1,2]. The clinical manifestations of malacia vary widely: barking cough, impaired mucous clearance, retractions, dyspnea and prolonged expiratory phase.…”

Section: Discussionmentioning

confidence: 99%

“…Premature infants are particularly susceptible to TBM: aside from their elevated compliance, they often receive barotrauma from prolonged positive pressure ventilation and they develop BPD [2]. The fact that the frequency of TBM remains the same despite introduction of new modalities of treatment and management of preterm infants (corticosteroids protocols, post-natal surfactant, non-invasive ventilation, etc.)…”

Section: Discussionmentioning

confidence: 99%

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Should Neonatologists Rule Out Tracheobronchomalacia in Every Premature Baby With Bronchopulmonary Dysplasia?

Khalife¹,

Feghali

Saliba

et al. 2019

J Med Cases

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“…8 Data from bronchograms performed within 30 days of tracheostomy were recorded for findings suggestive of tracheomalacia/ bronchomalacia using previously described methods. 9 Respiratory severity scores (RSS) were calculated by [MAP x FiO 2 ] to assess respiratory support for infants requiring assisted mechanical ventilation, as infants typically lacked arterial access. 10 RSS were calculated using the highest MAP and FiO 2 within the 72 hours prior and 72 hours following tracheostomy.…”

Section: Methodsmentioning

confidence: 99%