Use of tracheobronchography as a diagnostic tool in ventilator-dependent infants

Abstract

In cases of suspected abnormalities of the upper airway in small infants unable to be weaned from ventilatory support, tracheobronchography may be a more reliable investigation method than rigid bronchoscopy. The ability to assess the structural and dynamic components of the airway accurately and safely allows a correct and long-term treatment plan to be established in this group of patients.

Computed tomography versus bronchography in the diagnosis and management of tracheobronchomalacia in ventilator dependent infants

“…1 2 The diagnosis is important, as the management can be tailored to minimise frequent respiratory collapses and the need for reventilation, with concomitant complications. 3 TBM may be focal or diffuse, and results from softening of the tracheal and/or bronchial cartilages with development of flaccid airways with abnormal compliance. The exact pathophysiology for this is unclear.…”

“…Aliquots of approximately 0.2 ml were used, to a maximum of about 1.0 ml, as previously described. 3 The endotracheal tube was withdrawn into the upper trachea, using fluoroscopic guidance. Images were obtained with different levels of CPAP, with the patient breathing spontaneously above this level of CPAP throughout the study (fig 1).…”

“…3 Bronchoscopy has been used widely to investigate airway pathology in all age groups. However, bronchoscopy is particularly difficult in this group of patients with borderline lung reserve and small airway diameter, and potential limitations, such as splinting of the lesion by the bronchoscope or positive pressure, have been identified.…”

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

“…Bronchography was performed as previously described [5]. The patients were lightly sedated, intubated and were breathing spontaneously.…”

“…Contrast bronchography is currently the investigation of choice for ventilated infants in our institution [5]. It enables assessment of the trachea and the more distal bronchi, unlike bronchoscopy, and since it is performed in real time with the infant spontaneously breathing, the airways are assessed throughout the respiratory cycle.…”