Tracheobronchomalacia diagnosed by tracheobronchography in ventilator-dependent infants.
Background: Tracheobronchomalacia prevalence in premature infants on prolonged mechanical ventilation is high.
Objective: To examine the prevalence of tracheobronchomalacia diagnosed by tracheobronchography in ventilator-dependent infants, and describe the demographic, clinical and dynamic airway characteristics of those infants with tracheobronchomalacia.
Materials and methods: This retrospective review studies 198 tracheobronchograms performed from 1998 to 2011 in a cohort of 158 ventilator-dependent infantstracheobronchomalacia.
Results: Tracheobronchograms were performed at a median age of 52 weeks post menstrual age. The primary diagnoses in these infants were bronchopulmonary dysplasia (53%), other causes of chronic lung disease of infancy (28%) and upper airway anomaly (13%). Of those with bronchopulmonary dysplasia, 48% had tracheobronchomalacia. Prematurity (P=0.01) and higher baseline - pre-tracheobronchogram positive end-expiratory pressure (P=0.04) were significantly associated with tracheobronchomalacia. Dynamic airway collapse during tracheobronchography showed statistically significant airway opening at optimal positive end-expiratory pressure (P < 0.001). There were no significant complications noted during and immediately following tracheobronchography.
Conclusion: The overall prevalence of tracheobronchomalacia in this cohort of ventilator-dependent infants is 40% and in those with bronchopulmonary dysplasia is 48%. Infants born prematurely and requiring high pre-tracheobronchogram positive end-expiratory pressure were likely to have tracheobronchomalacia. Tracheobronchography can be used to safely assess the dynamic function of the airway and can provide the clinician the optimal positive end-expiratory pressure to maintain airway patency.
Bronchography; Bronchopulmonary Dysplasia; Female; Humans; Infant; Infant, Newborn; Male; Prevalence; Respiration, Artificial; Retrospective Studies; Tracheobronchomalacia
Airway; Bronchopulmonary dysplasia; Infants; Neonatology; Respiratory; Tracheobronchography; Tracheobronchomalacia
Manimtim WM, Rivard DC, Sherman AK, et al. Tracheobronchomalacia diagnosed by tracheobronchography in ventilator-dependent infants. Pediatr Radiol. 2016;46(13):1813-1821. doi:10.1007/s00247-016-3685-9