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Pediatric Surgery International

, Volume 34, Issue 1, pp 55–61 | Cite as

Bronchoscopic assessments and clinical outcomes in pediatric patients with tracheomalacia and bronchomalacia

  • Yuichi Okata
  • Tomomi Hasegawa
  • Yuko Bitoh
  • Kosaku Maeda
Original Article

Abstract

Background

Tracheomalacia and bronchomalacia (TM/BM) are one of the serious causes of airway obstruction in infants and children. This study reviewed our bronchoscopic assessments and clinical outcomes in pediatric patients with TM/BM, and investigated risk factors of surgical intervention for TM/BM.

Methods

Fifty-seven consecutive patients who were diagnosed as TM/BM by bronchoscopy between 2009 and 2013 were reviewed retrospectively. They were divided into two groups according to the presence (group E, n = 26) or absence (group N, n = 31) of acute life-threatening events and extubation failure (ALTE/EF). The severity of TM/BM was evaluated by Oblateness Index which was obtained from bronchoscopic images.

Results

Oblateness Index was significantly higher in Group E than in Group N. Patients in Group E underwent surgical intervention for TM/BM more frequently, and had significantly longer intubation period and hospital stay. Clinical symptoms of ALTE/EF, Oblateness Index ≥ 0.70, and multiple malacic lesions were significant risk factors indicating surgical events in patients with TM/BM.

Conclusions

Patients with TM/BM who had ALTE/EF had more severe malacic lesions indicating surgical intervention, and worse clinical outcomes. Oblateness Index is a simple and semi-quantitative index for bronchoscopic assessment of TM/BM, and can be one of the prognostic tools to predict clinical severity of pediatric TM/BM.

Keywords

Tracheomalacia Bronchomalacia Acute life-threatening event Surgical intervention 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

The present study was approved by our institutional review board, and the need for informed consent was waived for the retrospective review of clinical medical records and databases.

Human participants and animal statements

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

References

  1. 1.
    Maeda K (2017) Pediatric airway surgery. Pediatr Surg Int 33(4):435–443Google Scholar
  2. 2.
    Snijders D, Barbato A (2015) An update on diagnosis of tracheomalacia in children. Eur J Pediatr Surg 25(4):333–335CrossRefPubMedGoogle Scholar
  3. 3.
    Fayoux P, Sfeir R (2011) Management of severe tracheomalacia. J Pediatr Gastroenterol Nutr 52(Suppl 1):S33–S34CrossRefPubMedGoogle Scholar
  4. 4.
    Hysinger EB, Panitch HB (2016) Paediatric Tracheomalacia. Paediatr Respir Rev 17:9–15PubMedGoogle Scholar
  5. 5.
    Goyal V, Masters IB, Chang AB (2012) Interventions for primary (intrinsic) tracheomalacia in children. Cochrane Database Syst Rev 10:CD005304PubMedGoogle Scholar
  6. 6.
    Gupta P, McDonald R, Goyal S, Gossett JM, Imamura M, Agarwal A et al (2014) Extubation failure in infants with shunt-dependent pulmonary blood flow and univentricular physiology. Cardiol Young 24(1):64–72CrossRefPubMedGoogle Scholar
  7. 7.
    Mair EA, Parsons DS (1992) Pediatric tracheobronchomalacia and major airway collapse. Ann Otol Rhinol Laryngol 101(4):300–309CrossRefPubMedGoogle Scholar
  8. 8.
    Pan W, Peng D, Luo J, Liu E, Luo Z, Dai J et al (2014) Clinical features of airway malacia in children: a retrospective analysis of 459 patients. Int J Clin Exp Med 7(9):3005–3012PubMedPubMedCentralGoogle Scholar
  9. 9.
    Rogers DJ, Cunnane MB, Hartnick CJ (2013) Vascular compression of the airway: establishing a functional diagnostic algorithm. JAMA Otolaryngol Head Neck Surg 139(6):586–591CrossRefPubMedGoogle Scholar
  10. 10.
    Sanchez MO, Greer MC, Masters IB, Chang AB (2012) A comparison of fluoroscopic airway screening with flexible bronchoscopy for diagnosing tracheomalacia. Pediatr Pulmonol 47(1):63–67CrossRefPubMedGoogle Scholar
  11. 11.
    Hirasaka V (2005) Repair of tetralogy of Fallot with absent pulmonary valve using a new approach. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 132–134PubMedGoogle Scholar
  12. 12.
    Nomura N, Asano M, Mizuno A, Mishima A (2007) Translocation of dilated pulmonary artery for relief of bronchial compression associated with ventricular septal defect. Eur J Cardiothorac Surg 32(6):937–939CrossRefPubMedGoogle Scholar
  13. 13.
    Sakakibara Y, Atsumi N, Abe M, Ueoka K, Ikebukuro K, Mitsui T (1995) Relief of airway compression by enlarged pulmonary artery–modified palliative suspension of the artery after plication. Thorac Cardiovasc Surg 43(1):44–47CrossRefPubMedGoogle Scholar
  14. 14.
    Yamaguchi M, Ohashi H, Hosokawa Y, Oshima Y, Tsugawa C, Kimura K (1991) Surgical treatment of airway obstruction associated with congenital heart disease in infants and small children. Eur J Cardiothorac Surg 5(9):479–485CrossRefPubMedGoogle Scholar
  15. 15.
    Backer CL, Monge MC, Popescu AR, Eltayeb OM, Rastatter JC, Rigsby CK (2016) Vascular rings. Semin Pediatr Surg 25(3):165–175CrossRefPubMedGoogle Scholar
  16. 16.
    Hasegawa T, Yamaguchi M, Yoshimura N, Oka S, Nishijima E, Tsugawa C (2003) Vascular ring in an extremely low birth weight infant. Jpn J Thorac Cardiovasc Surg 51(12):688–691CrossRefPubMedGoogle Scholar
  17. 17.
    Iwaki R, Oshima Y, Maruo A, Hasegawa T, Matsuhisa H, Noda R et al (2015) Staged biventricular repair for absent aortic valve in a neonate. Ann Thorac Surg 99(5):e117–e119CrossRefGoogle Scholar
  18. 18.
    Masters IB, Zimmerman PV, Pandeya N, Petsky HL, Wilson SB, Chang AB (2008) Quantified tracheobronchomalacia disorders and their clinical profiles in children. Chest 133(2):461–467CrossRefPubMedGoogle Scholar
  19. 19.
    Masters IB, Eastburn MM, Wootton R, Ware RS, Francis PW, Zimmerman PV et al (2005) A new method for objective identification and measurement of airway lumen in paediatric flexible videobronchoscopy. Thorax 60(8):652–658CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Rozycki HJ, Van Houten ML, Elliott GR (1996) Quantitative assessment of intrathoracic airway collapse in infants and children with tracheobronchomalacia. Pediatr Pulmonol 21(4):241–245CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  • Yuichi Okata
    • 1
    • 3
  • Tomomi Hasegawa
    • 2
  • Yuko Bitoh
    • 1
    • 3
  • Kosaku Maeda
    • 1
  1. 1.Department of Pediatric SurgeryKobe Children’s HospitalKobeJapan
  2. 2.Department of Cardiovascular Surgery and Pediatric Critical Care MedicineKobe Children’s HospitalKobeJapan
  3. 3.Division of Pediatric Surgery, Department of SurgeryKobe University Graduate School of MedicineKobeJapan

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