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- Title
Tracheobronchomalacia diagnosed by tracheobronchography in ventilator-dependent infants.
- Authors
Manimtim, Winston; Rivard, Douglas; Sherman, Ashley; Cully, Brent; Reading, Brenton; Lachica, Charisse; Gratny, Linda; Manimtim, Winston M; Rivard, Douglas C; Sherman, Ashley K; Cully, Brent E; Reading, Brenton D; Lachica, Charisse I; Gratny, Linda L
- Abstract
<bold>Background: </bold>Tracheobronchomalacia prevalence in premature infants on prolonged mechanical ventilation is high.<bold>Objective: </bold>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.<bold>Materials and Methods: </bold>This retrospective review studies 198 tracheobronchograms performed from 1998 to 2011 in a cohort of 158 ventilator-dependent infants <2 years of age. Dynamic airway assessment during tracheobronchography determined the optimal positive end-expiratory pressure to maintain airway patency at expiration in those infants with tracheobronchomalacia.<bold>Results: </bold>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.<bold>Conclusion: </bold>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.
- Subjects
TRACHEOBRONCHOMALACIA; BRONCHOGRAPHY; MECHANICAL ventilators; NEONATOLOGY; POSITIVE end-expiratory pressure; DIAGNOSIS; ARTIFICIAL respiration; BRONCHOPULMONARY dysplasia; DISEASE prevalence; RETROSPECTIVE studies
- Publication
Pediatric Radiology, 2016, Vol 46, Issue 13, p1813
- ISSN
0301-0449
- Publication type
journal article
- DOI
10.1007/s00247-016-3685-9