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Tracheobronchial obstruction in children: experience with endoscopic airway stenting
Pankaj Kumar1, Andrew P Bush, George P Ladas
1Department of Thoracic Surgery, Royal Brompton Hospital, London, United Kingdom.
Insights
Pediatric tracheobronchial stenting offers significant symptomatic relief for children with airway obstruction, aiding in ventilator weaning and improving breathing. While effective, long-term outcomes depend on the underlying condition.
Area of Science:
- Pediatric Pulmonology
- Interventional Pulmonology
- Pediatric Airway Management
Background:
- Tracheobronchial obstruction in children presents complex management challenges.
- Endoscopic airway stenting is an intervention considered in severe pediatric airway compromise.
Purpose of the Study:
- To evaluate the role and outcomes of endoscopic airway stenting in pediatric patients with tracheobronchial obstruction.
Main Methods:
- A retrospective review of 17 children (2 months to 16 years) who underwent tracheobronchial stenting.
- Etiologies included vascular compression, anastomotic strictures, malignant masses, and post-intubation stenosis.
- Stents used were uncovered self-expanding metal stents and silicone stents.
Main Results:
- All deaths were attributed to underlying pathology, not stenting complications.
- Six of 8 ventilator-dependent children were successfully extubated post-stenting.
- Symptomatic improvement was observed in children stented for dyspnea, with a significant reduction in the Medical Research Council dyspnea score.
Conclusions:
- Tracheobronchial stenting is a valuable intervention for select pediatric cases of airway obstruction, often performed in critical situations.
- The procedure provides significant symptomatic benefits and facilitates ventilator weaning.
- Medium-term results for self-expanding metal stents in vascular compression are promising, but long-term prognosis is disease-dependent.
Background:
We reviewed our experience to determine the role of endoscopic airway stents in children with tracheobronchial obstruction.
Methods:
Seventeen children (10 boys and 7 girls) aged 2 months to 16 years underwent tracheobronchial stenting. Etiology of the tracheobronchial obstruction included external vascular compression (n = 9); tracheobronchial anastomotic strictures after heart-lung/lung transplantation (n = 4); airway compression by malignant mediastinal mass (n = 2), and subglottic/high tracheal stenosis after prolonged intubation with a tracheostomy in situ (n = 2). Indications for airway stenting were failure to wean from ventilator after a mean of 82.5 days (range, 2 to 210) in 8 children; and dyspnea or stridor in the remaining 9 children.
Results:
Ten children had a total of 24 uncovered self-expanding metal stents (either Magic Wallstent or Ultraflex Microvasive) and 7 children had silicone stents (2 straight, 3 Y and 2 T tube stents). At follow-up at 1 week to 72 months (median 21), only 8 of 17 (47%) children were alive but all the deaths were secondary to the underlying pathology and not related to tracheobronchial stenting. Six of 8 ventilator-dependent children were extubated after a mean of 5.3 days (range, 2 to 11) after airway stenting. For the 9 children stented for dyspnea, mean Medical Research Council dyspnea score decreased from 3.0 to 1.6 after stenting.
Conclusions:
Tracheobronchial stenting in children is only rarely needed and often undertaken in dire circumstances. The procedure has led to significant symptomatic benefit in dyspneic children and has enabled ventilator-dependent children to be extubated. Medium-term outlook after stenting with self-expanding metal stents for vascular compression of the airway is encouraging. The long-term outcome remains uncertain, however, and is ultimately influenced by the underlying disease.